
FROM 

THE ABBOTT ALKALOIDAL CO., 
CHICAGO. 



LIBRARY OF CONGRESS. 
-??Af-/3-2— 

Gijnii.- - Coptjriglji 1)a. 

Shelf*£.>£2 

UNITED STATES OF AMERICA. 



A THERAPEUTIC GUIDE 

TO 

ALKALOIDAL == DOSIMETRIC == 
MEDICATION. 



/ 



JOHN M. SHALLER, M. D., 

Professor of Physiology and Clinical Medicine 
in the Cincinnati College of Medicine and Sur- 
gery, and Professor of Comparative Physi- 
ology at the Ohio Veterinary College. 




CHICAGO. fT2~9^' 
W. C. ABBOTT, M. D., 

PUBLISHER. 
l8 95 . 



K 



^M' s » 




Entered, according to Act of Congress, in the year 1895 in the Office 
ci the Librarian of Congress at Washington, D. C, U. S. A. 



Chicago. 

W. C. Abbott, M. D. 

2666 Commercial street. 



PREPARE. 

The following pages are offered to students 
and practitioners of medicine simply as a guide to 
the practice of " Dosimetry," or Alkaloidal Med- 
ication. The book does not contain a complete 
scientific exposition of the physiological actions 
of the active principles of all plants, upon men 
and animals. Only such prominent physiologi- 
cal effects are described as will enable practi- 
tioners to prescribe them intelligently. Atten- 
tion is particularly given to the application of 
remedies in the treatment of the sick. 

Since the literature on the subject of these 
remedies is still meager in amount, the writer 
has been obliged to draw chiefly from his per- 
sonal experience. The dosage for children es- 
pecially, in the case of aconitine, has been par- 
ticularly difficult to ascertain and, only after 
prolonged experimentation, not unaccompanied 
with considerable anxiety, has a safe and efficient 
dose been determined upon. 

The text contains the subject-matter of two 
courses of lectures on "The Uses of Dosimet- 



4 PREFACE. 

ric Medicines," delivered in connection with 
lectures on Clinical Medicine to the students of 
the Cincinnati College of Medicine and Surgery. 

The thirty-odd remedies, an account of 
which formed the basis of the lectures, are con- 
sidered the most important in general use, and 
are usually sufficient to enable a general practi- 
tioner to treat successfully such cases as pre- 
sent themselves to him. 

The writer does not, however, wish to convey 
the idea that the list of alkaloidal granules con- 
tains all the medicines prescribed by dosimetric 
physicians. There are a great many excellent 
medicines which cannot be prepared in granules 
or even in tablets, and there are others, prepared 
in this way, which cannot produce any effect 
whatever, when given in such doses as these 
granules contain. This much, however, is cer- 
tain, that the more important remedies are pre- 
pared in granule form, and that the majority of 
diseases are treated more successfully by 
giving small and frequently repeated doses of 
active principles, than by giving cruder prepar- 
ations in large doses at long intervals of time. 

Not all the medicines used in dosimetry are 
alkaloids. Among them are found resinoids, 
glucosides, acids, salts of various metals, ex- 
tracts, and various chemical combinations and 
other substances which cannot be classed with 
the above, as pepsin, diastase, iodoform, nitro- 
glycerin (glonoin), camphor monobromide, etc. 



PREFACE. 5 

If a perusal of the following pages shall en- 
able medical practitioners to apply the active 
principles of plants, successfully, for the allevia- 
tion and cure of disease, the object for which 
they have been written will have been accom- 
plished. In recasting the lectures into the pres- 
ent form, frequent recourse was had to the 
works of Burggraeve, Castro, Bartholow, H. C. 
Wood, Potter and Waugh, and to " The 
National Dispensatory," Sajous, " Annals of 
Universal Medical Sciences," and to the " Ref- 
erence Handbook of Medical Sciences." 



^yO^ 



DEDICATION. 



I dedicate this book to my wife, whose assist- 
ance and advice have always been valuable 
to me. 

The Author. 



PUBLISHER'S STATEMENT. 

It has given me great pleasure to put Pro- 
fessor Shaller's manuscript into shape for this 
book and I desire to thank him for selecting me 
as publisher, in which capacity I have gone care- 
fully over all matter herein contained and most 
heartily recommend it to the honest seeker after 
knowledge along alkaloidal lines. I believe that 
this book, from a practical American physician 
to the American profession, will be an important 
stepping stone to the inevitable adoption of the 
active principle as the basis of scientific medi- 
cation. W. C. Abbott, M. D. 

2666 Commercial St., Ravenswood, Chicago. 



CONTENTS. 

Chapter. Page. 

Introduction n 

I. ACONITINE 23 

II. Agaricin . . 38 

III. Apomorphine 40 

IV. Arbutin 48 

V. ASPARAGIN . 49 

VI. Atropine 52 

VII. Bryonin 61 

VIII. Cactin 63 

IX. Caffeine 64 

X. Calcium Sulphide 67 

XI. ClCUTINE ^. . 72 

XII. Colchicine ....... 74 

XIII. Convallamarin 78 

XIV. Copper Arsenite 80 

XV. Digitalin 84 

XVI. Emetine 97 



CONTENTS. 

XVII. Ergotin 102 

XVIII. Gelseminine . 108 

XIX. Glonoin ...... .114 

XX. Hyoscyamine . . . . 121 

XXI. LOBELINE 127 

XXII. Mercury Bichloride and Cal- 
omel 128 

XXIII. Morphine and Codeine . . .135 

XXIV. Pilocarpine 144 

XXV. PODOPHYLLIN 151 

XXVI. Quassin 153 

XXVII. Quinine 154 

XXVIII. SCILLITINE . l6o 

XXIX. Seidlitz Salt .... 161 

XXX. Sparteine 164 

XXXI. Strophanthin 166 

XXXII. Strychnine 168 

XXXIII. Veratrine . 179 

XXXIV. Zinc Sulphocarbolate . 182 

Appendix .194 

Index ' 198 



INTRODUCTION. 

About fifty years ago, Professor Adolph 
Burggraeve, of the University of Ghent, con- 
ceived the idea of administering in disease, 
according to certain simple rules, the active 
principles of plants prepared in granules. 

Because the medicines were "mathematically 
measured " in small doses, the name "Dosimetry" 
was applied, to distinguish this method of pre- 
scribing from others then in vogue. 

It is not claimed that dosimetry is a new 
system or that it is a complete practice. The 
active principles of plants, which have been used 
for ages in cruder form, are prepared in granules. 
This is done for the purpose of convenient dis- 
pensing and of assuring accurate dosage. That 
granules contain accurate doses is evidenced by 
the fact that uniform results are always obtained, 
and fatal effects have never been observed. 

One of the precepts of dosimetry, or alkaloidal 
medication, is: "To acute diseases oppose acute 
treatment, to chronic diseases chronic treatment. ." 
— Burggraeve. 



12 INTRODUCTION. 

These granules represent a minimum adult 
dose and, in acute diseases, they may be admin- 
istered every fifteen minutes, every half hour or 
every hour, according to the severity of the attack, 
until some improvement is manifested. The 
medicine should then be given at greater inter- 
vals. By pursuing this method closely it is 
simply impossible to overdose the patient. On 
this account the use of the alkaloids and other 
active principles and powerful drugs are perfectly 
free from danger. To insure better absorption 
of the granules, treatment is usually begun by 
giving a dose of seidlitz salt to clear and freshen 
the alimentary canal. 

In cases in which the mucous membrane of the 
mouth is very dry, indicating that stomach solu- 
tion will be slow, it is best to prepare a solution 
of the granules in water. Combinations may be 
made with different granules without the fear of 
chemical incompatibility except in the case of 
tannin. This granule should never be given 
with any alkaloid, as it forms an insoluble 
tannate. 

Another advantage of the alkaloidal method is 
that in acute diseases, active treatment is begun 
immediately, even before a positive diagnosis 
can be made. This is done with the hope of 
checking the progress of the impending disease 
and of aborting fever. 

Physicians who have tried this method testify 
to its wonderful efficacy in jugulating many acute 



INTRODUCTION. 13 

febrile diseases, a thing comparatively easy to do 
at the beginning of the attack. The medicines 
used for this purpose, are aconitine, digitalin ; 
and veratrine. 

There is no recognized dose, for no one can 
possible say how much of a given remedy will be 
required to relieve a symptom, therefore mini- 
mum doses should always be given and repeated 
frequently until the desired effect is obtained. 
Those physicians who use dosimetric granules 
are constantly upon the alert in order that harm- 
ful tendencies of disease may be anticipated. 
In capillary bronchitis, in peritonitis and in diph- 
theria, paralysis frequently occurs. Now, we 
do not wait until there are evidences of 
paralysis, but we apply our remedy before 
paralysis makes its appearance; that is, we 
anticipate it. 

All schools of physicians use but one medicine to 
stimulate paralyzed nerves and to restore para- 
lyzed muscles; and that remedy is strychnine. 
There is no other medicine but strychnine that 
can so effectually stimulate the vital functions 
and arouse nerve force. 

If strychnine is a proper remedy to use to cure 
paralysis, it is also a proper remedy to use to 
prevent paralysis. Whether paralysis is actually 
threatened or not, the administration of strych- 
nine cannot harm the patient but, on the con- 
trary, it must greatly benefit him, for it is the 
best general tonic we possess. There is hardly 



i 4 INTRODUCTION. 

a disease in which strychnine may not be given 
to good advantage to the patient. 

In the treatment of infectious diseases, the 
materies morbi is never lost sight of and 
every endeavor is made to elimina^ and to neu- 
tralize it; first by the action of the seidlitz salt 
upon the intestines, kidney and skin, then by 
the administration of calcium sulphide through- 
out the entire course of the disease. In the 
blood, the sulphuretted hydrogen evolved from 
calcium sulphide may neutralize the products 
of germ activity, but it also acts upon the 
secretions. 

The cause of disease always should be sedu- 
lously sought for, with the object of applying 
treatment directly to it. In typhoid fever a 
specific germ inhabits Peyer's patches. These 
germs and the absorption of their products cause 
the fever. Every endeavor should be made to 
clear the intestines of the fermenting germ 
products and to prevent their absorption. 
Calomel and sulpho-carbolate of zinc are prob- 
ably the best remedies for this purpose and 
the latter should be given throughout the entire 
course of typhoid fever. 

This is called dominant treatment, which means 
treatment directed against the cause of the 
disease, and if the cause is unknown, treatment 
must be directed against the most prominent 
symptom. Rachitis requires salts of lime. 
Inflammation requires aconitine. Paludal infec- 



INTRODUCTION, 15 

tion requires quinine, etc.. Whatever concomi- 
tant symptoms arise during the course of 
disease, as pain, diarrhoea, vomiting or insom- 
nia, require what is called variant treatment. 
This treatment is limited to the symptom and is 
discontinued as soon as relief is obtained, while 
the dominant treatment is continued as long as 
the disease lasts. 

DISPENSING GRANULES. 

Granules are most conveniently dispensed in 
one-half drachm glass vials, or in wooden bottles, 
number"oo." The former hold about one hundred 
granules and the latter about fifty granules. It 
is best to have the bottles labled with the direc- 
tions for the administration of the granules 
and the first two or three letters of the name of 
the remedy employed written thereon. If 
arsenite of strychnine is given, ar. st. is 
written; if aconitine, aeon.; if atropine, at., 
and so on. When prescribing for young 
children, a solution is needed. In the office, 
three-ounce vials filled with water should always 
be at hand. The granules should be crushed in 
a mortar and dissolved in water. 

If the granules contain bitter medicine, a little 
saccharine may be added. When visiting 
patients at their houses, a three ounce vial may 
be used, or twenty-four teaspoonfuls of water 
may be measured into a tumbler, and the proper 
number of granules dissolved in this. 



16 INTRODUCTION, 

Always be accurate, and know how many 
granules are given, and in how much water they 
are dissolved. To throw an unknown number 
of granules into an unknown quantity of water, 
with the directions to take a teaspoonful, is 
criminal carelessness, and shows rank ignorance 
of the potency of the granules. From such care- 
lessness, harm to the patient must certainly follow. 

Where patients, especially infants, require 
larger quantities of medicine than usual to afford 
relief, a note should be made of it and thus, by 
accurately observing the dose and its effect, a 
large amount of useful information can be 
obtained, which cannot possibly be had in any 
other way. 

Each standard granule represents, as a rule, 
a minimum dose for an aduit, which may be re- 
peated every half hour or oftener. Most of the 
granules are not poisonous, and two or three 
may frequently be given at a dose. Aconitine. 
cicutine, gelsemin, and veratrine should be 
given only in doses of one granule. 

In prescribing for children, the writer has 
found it convenient to use a three-ounce vial or 
to measure twenty-four teaspoonfuls of water 
into a tumbler. Any other quantity of water 
can be used, of course, but it will be found ad- 
vantageous to use a certain quantity, in order 
that doses may be easily calculated. 

If twenty-four granules were dissolved in a 
three ounce vial, one teaspoonful would repre- 



INTRODUCTION. 17 

sent one granule, which is ordinarily a dose for 
an adult. 

The following rule has been formulated by the 
writer for administering aconitine to children 
and it has proved a perfectly safe rule to follow 
when standard granules of any of the active 
principles are to be given, as veratrine, cicutine, 
gelsemin, hyoscine, etc. 

Dissolve in twenty-four teaspoonfuls of water, 
one granule for each year of the patient' 's age to- 
gether with one additional granule. For a child 
of two years, dissolve three granules, for a child 
of one year two granules in twenty-four tea- 
spoonfuls of water. An infant of six months re- 
quires only one granule in twenty-four teas- 
poonfuls of water, while one of three months re- 
quires one granule in forty-eight teaspoonfuls of 
water. 

Ateaspoonful of the solution may be given, 
usually, every hour but, in severe cases, a tea- 
spoonful of the solution may be given every half 
hour until improvement is manifested. This 
rule applies only to those medicines which are 
considered actively poisonous, as aconitine, ver- 
atrine, gelsemin, atropine, morphine, codeine, 
and hyoscyamine. There are many granules, as 
asparagin, calcium sulphide, emetine, iron, scil- 
litin and zinc sulpho-carbolate, which require 
larger doses and are not poisonous medicines. 

There is absolutely no reason to fear evil re- 
sults from administering alkaloids according 



18 INTRODUCTION. 

to Burggraeve's method. There is no safer 
method known and why physicians hestitate to 
use alkaloids in known quantities is difficult to 
comprehend. If the writer were compelled to 
give a prescription for active principles, to 'be 
filled by some druggist who has obtained his 
medicines from various manufacturers, there 
would necessarily be hesitancy on his part, but, 
when he is supplied by a reliable firm, as " The 
Abbott Alkaloidal Company," of Chicago, whose 
granules are uniform in action, and consequently 
must be accurate and pure, he feels no hesitancy 
in giving aconitine, hyoscyamine and strychnine 
even to the youngest infant. 

The granules are even pure enough to use hy- 
podermically, as the writer has done with glo- 
noin, aconitine, morphine, atropine, pilocarpine 
and others. 

When rapid effects are desired, they may be 
dissolved in hot water and administered. 

Of course there are objections raised against 
dosimetry. In the first place, because it is as- 
sumed by some to be a new system of medicine. 
But it is not a new system of medicine. 
It is stated by the late Dr. Marchal " a great 
fact." It is simply a method of administering 
active principles in a perfectly safe and effective 
manner according to certain rules laid down by 
Professor Burggraeve. 

Some declare that dosimetry borders on hom- 
eopathy, because little pills are used, and be- 



INTRODUCTION. 19 

cause the physician dispenses his own medi- 
cine in a way similar to that of a homeopathic 
practitioner. This is rather puerile, as chewing 
a few granules of quassin is sufficient to show. 

Others affirm that alkaloids are dangerous med- 
icines. So they are in the hands of the unenlight- 
ened and so is any medicine, except homeopathic 
medicine. The danger is removed by know- 
ledge sufficient for a proper diagnosis and by 
an understanding of the physiological action of 
remedies. 

Those physicians who object to alkaloidal 
granules which contain known quantities, do not 
object to giving infusions, tinctures, fluid and 
solid extracts, all of which must contain alka- 
loids, and in unknown quantities. 

A physician cannot take a bottle of the tinc- 
Ture of aconite root, ordinarily found in drug 
stores, and tell exactly how much aconitine there 
is in a single dose. It must be that he does not 
want to know how much active principle he is 
using and, therefore, gives the cruder prepara- 
tion. 

It is urged as another objection that all of the 
alkaloids or active principles are not simple 
bodies; and this is true. But those who pre- 
scribe them are aware of the fact. They know 
that veratrine, digitalin, and it may be some 
others, contain several active principles. While 
this is true, the important question in the treat- 
ment of the sick nevertheless remains, " What 



20 INTRODUCTION. 

results are produced by the use of these medi- 
cines?" These results are known and are all that 
can be desired. Besides, the purest active med- 
icinal substances which chemistry can separate 
from plants are always used and, as soon as 
chemists can isolate simple active principles, 
they will replace the compound ones now in use. 

Some objection has been very properly made 
to the common names given to the granules, as 
calomel, iron, mercury and sugar of lead, in- 
stead of the chemical names as found in the 
United States Dispensatory. Why these com- 
mon names have been adhered to, I do not 
now know and I have no hesitancy in saying that 
it would appear more in accord with scientific 
knowledge, to use the recognized nomenclature 
of the United States Dispensatory. 

It has always appeared to me strange that 
physicians should ask if patients do not object 
to the change from the usual method of pre- 
scription writing to the use of the granules. 
On the contrary it is the experience of the 
writer that patients always express themselves as 
highly pleased with the change; not only are 
the granules more palatable, but patients very 
quickly observe that the results obtained are bet- 
ter and follow more speedily than before, and they 
absolutely refuse to go back to the older ways. 
And not only does the patient learn of the won- 
derful potency and efficacy of the granules, but 
the physician himself is often astonished at the 



INTRODUCTION. 21 

excellent results obtained, becomes inspired 
with a new enthusiasm and awakens to the fact 
that he can better alleviate and cure than form- 
erly. The writer has had years of experience 
in writing prescriptions and also in dosimetry, 
and he has no hesitancy in saying that his re- 
sults with dosimetric granules have far surpassed 
what he was able to do while using cruder prep- 
arations of drugs. 



<^o^> 



A THERAPEUTTC QCJIDE 

TO 

ALKAL0IDAL-D05IAETRIO* 
ftEDICATION 

CHAPTER I. 

ACONITINE (ALK>. 

Standard granule — Gr. 1-134 of the amorphous. 

Dose — One every % to %. or 1 or 2 hours, according to 
the conditions. 

Aconitine is an alkaloid, and is the active 
principle of the leaves and root of Aconitine 
Napellus. According to Wright the yield of 
aconitine from the root is 0.07 per cent. 

In dosimetric medicine two forms of aconitine 
are used, the amorphous and the crystalline. 
The amorphous is prepared in granules which 
contain different amounts of the active principle. 
There are granules containing gr. 1-134, grm. 
.0005, and others containing gr. 1-500, grm. 
.000125. The crystalline is prepared only in 
granules which contain gr. 1-500, grm. .000125. 
If a granule of aconitine is held in the mouth 
and allowed to dissolve, within ten. minutes a 



2 4 ACONITINE. 

tingling sensation is perceived in the lips, tongue 
and fauces. If aconitine is taken in larger 
doses, or if smaller doses are repeated very fre- 
quently, tingling is felt in the fingers and toes, 
then in the hands and feet, and finally in all 
parts of the body. The tingling or numbness 
is the first physiological manifestation which 
shows that the system is fully under the in- 
fluence of aconitine. Numbness is rarely pro- 
duced while treating fever with aconitine. Prob- 
ably the presence of fever prevents this action; 
at any rate it is not necessary in order to reduce 
fever that tingling should be manifest. Harm 
cannot result until the patient first feels this 
numbness. 

In treatment of adults, therefore, no danger 
can arise from medicinal doses of aconitine, if 
the medicine is withdrawn when the patient per- 
ceives the sensation of numbness When acon- 
itine is indicated we are justified in pushing its 
use, if relief is not obtained, until tingling, the 
one physiological effect described above, is man- 
ifested. The tingling is produced by paralysis 
of the end-organs of the sensory nerve-fibres. 
This physiological effect is utilized in the treat- 
ment of neuralgia, hyperesthesia, sprains and 
contusions. The first two may be treated by the 
internal administration of aconitine or by the 
local application of aconitine in the form of an 
ointment, in the proportion of two grains to the 
drachm of lard. Sprains and contusions may 



ACONITINE. 25 

be treated by a liniment composed of tincture of 
aconite root one part, ext hamamelis distilled 
five parts. In the treatment of many stubborn 
neuralgias, especially of the facial nerve, it is 
absolutely necessary before relief can be ob- 
tained, to give aconitine in increasing doses un- 
til its full physiological effects are produced. 
A cure is more easily affected in the treatment 
of neuralgia, by combining aconitine with 
arseniate of quinine, with gelsemin or with mor- 
phine. 

With reference to the tingling, the question 
might be asked, "How is it in regard to 
little children and infants who cannot express 
themselves or indicate their sensations?" 
In the first place, it should be remembered that 
tingling of the extremities is rarely produced by 
aconitine in dosimetric treatment of fevers. 
Further, as prominent symptoms subside, acon- 
itine should be withdrawn and too much of the 
remedy is therefore not likely to be given. 
Lastly, the writer has never seen a case which 
was treated with aconitine, according to Burg- 
graeve's method, in which an untoward or alarm- 
ing symptom, danger, or death has been pro- 
duced. 

This may appear to be a bold statement to 
make in the face of warnings uttered by various 
writers of prominence who say that aconitine 
should never be used internally, and that 
it is unsafe. If the physicians who made the 



26 ACONITINE. 

above remarks had ever used aconitine in 
small doses frequently repeated in the treat- 
ment of fevers, it would have been impossible 
for them to have made such statements. 

It seems strange to read such adverse com- 
ments about a remedy which physicians use 
daily and know from experience that it is the 
most effective, the most reliable, and the safest 
of all the alkaloids of dosimetric medicine. 

When one granule of aconitine amorphous, gr. 
1-134, grm. .0005, is taken every half hour, the 
number of pulsations and respirations is re- 
duced, the arterioles are dilated, the capillaries 
are flushed wiA blood, the blood pressure is 
lowered through the action of vaso-motor nerves 
and all of the secretions are augmented. The 
effect of aconitine upon the secretions is shown 
by the moistened tongue and skin, the increased 
flow of urine, and if the dose has been excessive, 
by the diarrhoea, and sometimes by the vomiting 
of mucus. 

In disease, the effect of aconitine upon the 
glandular structure is more marked than in 
health. During high fever the skin is hot and 
dry, the urine is scanty, the bowels are consti- 
pated and the tongue is dry, heavily coated, 
brown or glazed. The patient may be com- 
atosed and may breath heavily or he may be 
restless and delirious; he ma)' suffer also from 
great thirst, from general soreness and pain and 
the pulse may be rapid. Under these conditions 



ACONITINE. 27 

if one granule of aconitine amorphous, gr. 1-134, 
grm. .0005, is given every half hour, great 
changes are soon produced. The skin is covered 
with perspiration, the quantity of urine is aug- 
mented, the bowels are moved, the tongue grows 
moist, the patient is aroused from his coma, or 
is relieved of his restlessness and delirium; his 
thirst and pain disappear, his pulse, respiration 
and temperature are reduced to normal. 

By closely observing the tongue in fevers, we 
are able to judge of the progress of the action 
of aconitine. As long as the tongue remains 
dry, no impression has been made upon the 
general secretions and no progress has been 
made in the case but, as soon as the tongue 
grows moist, general improvement follows. 

In the use of aconitine, no question need be 
asked concerning the kind of fever for which it 
is suited. It may be used in all kinds of 
fevers, from those occurring during the first 
days of infancy, throughout life, to extreme old 
age, irrespective of the cause. Wherever there 
is fever aconitine is indicated. Aconitine is not 
only the febrifuge of dosimetry, but without 
doubt, it is the best antipyretic known. 

Aconitine is the great jugulator of fevers. 
Every endeavor should be made to adminis- 
ter it as early as possible in the course 
of an acute disease. While it is always easy to 
detect fever, provided a thermometer is used, it 
is not always easy to detect the cause ' 



28 ACONITINE. 

Active treatment should, however, be begun at 
once. To give a placebo and wait until to- 
morrow in order to make a positive diagnosis 
before beginning active treatment, is an unneces- 
sary loss of very valuable time. Fever is pres- 
ent and that is a sufficient indication for treat- 
ment, without waiting to make a positive diagno- 
sis. The fever, indicated by a rise in tempera- 
ture, is ominous and may prove serious. When 
the human body is plainly showing, by many 
signs, as an abnormal temperature, chilliness or 
rigor, headache, backache, general lassitude, a 
quickened pulse and respiration, that an inflam- 
matory disease is threatening to attack some organ 
or structure, experience is powerless to indicate 
where the general storm which seems to be 
gathering throughout all parts of the organism 
will finally localize its entire force. If this 
force is localized, it will produce congestion 
and congestion usually leads to inflammation. It 
is our duty to attempt to prevent the general 
storm from making headway and attacking a 
single organ or, if too late for this, to jugulate 
the congestion or even to strive to hold in 
check the inflammation, if it has occurred; and, 
notwithstanding the preponderance of opinion 
against it, this can frequently be done. 

Every case which presents itself with prodro- 
mal febrile symptoms, if unchecked by nature or 
art, will terminate in fever. This should be fully 
realized and, as soon as the case is seen, whether 



ACONITINE. 29 

fever is present or not, aconitine should be 
given every hour and continued until im- 
provement is manifested. The result will be 
that in many cases the various symptoms will 
soon disappear. If fever has been present the 
temperature may be restored to the normal within 
twenty-four hours. Some cases may run their 
course but the probabilities are that the course 
will be much shorter under treatment with 
aconitine than with any other medicine. This 
has been the writer's experience and this is his 
chief reason for using aconitine in the treat- 
ment of fevers. 

Not all cases can be jugulated, chiefly because 
their incipiency does not always come under the 
observation of the physician. Frequently I have 
seen temperatures of 101 to 105 degrees restored 
to the normal within twenty-four hours. With- 
out positive evidence, of course, I nevertheless 
believe that, if treatment had been delayed one 
day, the termination could not have been so 
favorable. When first seen, some of these cases 
were in their early congestive, others in their 
early inflammatory stages. Marked inflammatory 
changes had not as yet occurred. Whatever 
organ or structure was threatened it contained an 
increased supply of blood. The vaso-motor 
nerves were paralysed- and allowed an afflux of 
blood into the threatened structure, while all 
of the remaining structures of the body were drain- 
ed and their arterioles were probably contracted. 



3 o ACONITINE. 

The equilibrium of the blood supply was de- 
stroyed through inharmonious action of the vaso- 
motor centres. A hyperaemia was produced in 
one part, an anemia in all other parts of the 
body. 

When aconitine is administered to patients 
whose blood-supply is thus disturbed, an har- 
monious action of the vaso-motor centers is soon 
produced. The contracted arterioles dilate and 
the blood is withdrawn from the congested area. 
A large amount of blood being thus drained off, 
the congestion is relieved, an inflammation is 
prevented, a disease is aborted. 

The following plan for the administration of 
aconitine in fevers, which has been founded upon 
an extended personal experience of the writer, 
can be recommended as being perfectly safe and 
highly effective. 

One granule of aconitine amorphous, gr. 
i- 134, is the dose for an adult and may be 
given every fifteen minutes, every half hour, or 
every hour according to the degree of fever. 
If the temperature ranges between 100 degrees 
and 103 degrees, a granule of aconitine amor- 
phous, gr. 1 -134, grm. .0005, should be given 
every half hour. If, however, the thermometer 
registers from 103 degrees to 105 degrees the 
same dose should be given every fifteen minutes. 
In both cases, the medicine must be continued 
until some improvement is manifested; the same 
dose can then be administered every one or two 



ACONITINE. 31 

hours. If the patient is comatosed, one granule 
of aconitine may be injected subcutaneously every 
half hour until the fever declines or until he is 
able to swallow. To children only a fraction of 
a granule can be given as a dose and this should 
always be administered in a solution, which is made 
as follows: Measure into a glass twenty-four tea- 
spoonfuls of water, or use a three-ounce vial of 
water. Drop into the water one granule of 
aconitine amorphous, gr. 1-134, for each year 
of patient's age, together with one additional 
granule; that is, for a child one year old, two 
granules; for a child five years old, six granules, 
etc. ; for infants of six months, one granule. Of 
this solution, one teaspoonful may. be given 
every fifteen minutes, every half hour or every 
hour, according to the degree of fever or the 
urgency of the case. In the treatment of 
children, as in the treatment of adults, as soon 
as improvement is observed, the medicine should 
be given less frequently. For infants under 
six months of age, the dose prepared for a child 
of six months should be administered as follows: 
If the child is under one month of age, fifteen 
drops of the solution may be given. If the child 
is one, two or three months old, one-half tea- 
spoonful of the solution will be a sufficient and safe 
dose. If no improvement in the patient's condi- 
tion follows within twelve hours, the dose may 
be gradually increased to one teaspoonful. The 
writer has frequently given aconitine to infants 



32 ACONITINE. 

a few days old, and he has never known of harm 
resulting to the patient. The great safe-guard 
in the use of an alkaloid, according to the rules 
laid down by Burggraeve, is that as soon as im- 
provement is manifested the medicine should be 
withdrawn either gradually or entirely. Gradual 
withdrawal is best as it prevents a return of fever. 
How can the attendant know when to withdraw 
the medicine gradually and to begin giving it at 
greater intervals ? If the patient has been restless 
and delirious and becomes quiet, if thirst, lassi- 
tude and soreness disappear, if the dry skin and 
tongue becomes moist, then, instead of giving 
aconitine so often, it should be given every 
one or two hours. 

If after a time fever returns, aconitine may be 
given as frequently as at the beginning of the treat- 
ment. 

It should be remembered that generally the 
pulse is restored to the normal before the fever 
has been reduced. 

How long may aconitine be administered? It 
may be administered continuously for weeks 
but it is best to combine it with strychnine and 
digitalin, as it is in the preparation of the gran- 
ule known as "Dosimetric Trinity." 

Aside from its systemic use in the treatment of 
fevers, aconitine may be used to advantage in 
inflammations of the mucous membrane of the 
mouth and pharynx. For this purpose it should 
be given in solution and, when thus frequently 



ACONITINE. 33 

administered, aconitine acts as a local anesthetic 
and relieves the pain which usually accompanies 
these diseases. 

Aconitine reduces the number of respirations 
and should be used, therefore, in all inflamma- 
tory diseases of the lungs, in which there is al- 
ways increased respiration. There is no remedy 
that can cure acute diseases of the entire 
respiratory tract so quickly and so thor- 
oughly as aconitine. These are also among the 
diseases which can be aborted. In the treat- 
ment of bronchitis, emetine and scillitin may be 
combined with aconitine, to modify the character 
of the sputum and to make expectoration easier. 

In cases of hypertrophy of the heart, in which 
the contractions have become too vigorous, one 
granule of aconitine given every two hours will 
reduce the force of the beat. 

While aconitine may produce vomiting and 
diarrhoea when given in small doses to suscep- 
tible patients, and while large doses usually pro- 
duce irritation of the stomach and intestines, 
still it is not contra-indicated in inflammatory 
diseases of the gastro-intestinal canal; because 
it may be administered with codeine, which 
prevents the irritant action of aconitine. 

In all inflammatory diseases of the puerperal 
state, as pelvic peritonitis and metritis, aconitine 
reduces fever with remarkable rapidity. 

If adynamia is present, strychnine and digita- 
lin must be added to the aconitine. It should 



34 ACONITINE. 

be remembered, that there is no disease accom- 
panied by fever in which aconitine may not be 
given with advantage. In scarlet fever, measles, 
diphtheria and in small-pox, aconitine and cal- 
cium sulphide are among our best remedies. In 
acute articular and in muscular rheumatism, in 
erysipelas and in meningitis, aconitine will give 
better satisfaction in the reduction of fever, and 
consequently in the relief of pain, than any other 
antipyretic. 

In the treatment of asthenic cases with aconi- 
tine, Burggraeve uses the combination of acon- 
itine amorphous gr. 1-134, grm. .0005, digitalin 
gr. 1-67, grm. 001, and strychnine arseniate gr. 
1-134, grm. 0005. These three active principles 
are prepared in a granule known as Dosimetric 
Trinity No. 1. Another granule is prepared 
containing one-fourth of the quantity of the 
active principles found in No. 1. and called 
Dosimetric Trinity No. 2*. This latter gran- 
ule may be used in the treatment of diseases of 
children. When Dosimetric Trinity No. 1 is 
used in the treatment of adults, or of children, 
it should be given in the same dose, and accord- 
ing to the same method, laid down for the ad- 
ministration of aconitine. This granule may be 
given in all cases of fever, especially cases in 
which the patient is delicate, and the heart is 
feeble. When preparing Dosimetric Trinity 

*These compound granules were first prepared and in- 
troduced by The Abbott Alkaloidal Company of Chicago. 



ACONITINE. 35 

in solution for administration to children, sacchar- 
ine should be added to correct the bitterness. 

In the granule known as Dosimetric Trinity, 
aconitine is an antipyretic, digitalin a heart tonic 
and antipyretic, while strychnine is a heart, lung 
and nerve stimulant. The slight antagonism 
which exists between aconitine and digitalin is 
not sufficient to destroy the property of aconitine 
as a febrifuge, and it also aids aconitine in reduc- 
ing fever. The combined action of digitalin and 
strychnine in sustaining the heart, and particu- 
larly the action of strychnine as a respiratory 
stimulant, prevents pulmonary depression by 
the action of aconitine. 

According to Harley, death is produced in 
cases of poisoning by aconitine through its action 
upon the medulla. There is incomplete paraly- 
sis of the diaphragm, spasmodic action of the 
muscles attached to the r upper part of the chest, 
but no complete muscular paralysis. The heart 
continues to beat after the lungs have ceased to 
perform their function. 

" Fothergill's experiments on rabbits, guinea- 
pigs and cats, show that a lethal dose of aconi- 
tine ceases to be so if the animals have had an 
appropriate dose of digitalin from five to nine 
hours previously. In like manner, the lethal 
effects of aconitine are prevented bv atropine 
and strychnine." 

"While aconitine kills by paralyzing the res- 
piration, atropine and strychnine, which act 



36 ACONITINE. 

powerfully on the respiratory centers, are potent 
to prevent death." — Nat. Dispensatory. When 
aconitine is thus guarded by two such remedies 
as digitalin and strychnine, as in Dosimetric 
Trinity, it is almost impossible for harm to follow, 
even though it be carelessly administered. 
That it is efficient in reducing fever, thousands 
of physicians can testify and the most skeptical 
must be convinced by a few trials of this com- 
bination. 

Probably the most potent combination known 
for the reduction of fever, is formed of amorphous 
aconitine, gr. 1-134, g rm - •°°°5j digitalin, gr. 1-67, 
grm. .001, veratrine, gr.1-134, grm. .0005 and is 
named Defervescent Compound No. 1*. There 
is also a granule prepared which contains one- 
fourth of the quantity of medicine found in No. 1, 
and is called Defervescent Compound No. 2. 
Defervescent Compound No. 1. should be used 
for adults, and only in sthenic cases, in which 
the heart beats forcibly, the fever is high, the 
patient is strong, the face congested and the 
arteries in the neck and temples are visibly 
throbbing. 

In many cases of pneumonia, pleurisy, rheu- 
matism and peritonitis, this granule will be 
found of great value in quieting the heart's 
action and in reducing fever. One granule may 
be given every half hour until improvement is 

*These combination granules were first made and named 
as above by The Abbott Alkaloidal Company. 



ACONITINE, 37 

manifested, after which it should be given every 
hour or every two hours. 

Defervescent Compound No. 2 may be given 
to children from eight years old and upwards, 
but it should never be given to frail, delicate 
children. Dosimetric Trinity should be used in 
these cases. 

That which recommends aconitine for gen- 
eral use, especially for the treatment of children, 
is, not only its wonderful efficacy and safety, but 
its tastelessness. Children take it in solution 
without a murmur. In fact, they are not even 
aware that they are taking medicine. 

Frequently it is the only remedy needed. Its 
administration is so simple, and yet so satisfac- 
tory, that the writer feels it to be his duty to 
urge upon physicians, who do not dispense their 
own medicines, to carry with them at least some 
aconitine amorphous granules gr. 1-134, grm. 
.0005 and use them whenever fever is present. 
Physicians may feel, as did the writer when he 
first used this method, that one or two granules 
dissolved in twenty-four teaspoonfuls of water 
could not, when administered in teaspoonful 
doses, be productive of good, and much less of 
harm. 

But of this the practitioner may rest assured, 
that a few trials of this wonderful and unfortu- 
nately not fully appreciated febrifuge, will con- 
vince him that there is no remedy equal to it in 
reducing fevers " quickly, safely, and agreeably." 



CHAPTER II. 

AGARICIN (GLU.)- 

Standard granule — Gr. 1-67. 

Dose — Three to six (average four) granules, repeated 
every two to four hours as necessary. 

Agaricin is the active principle of Agaricus 
Alba. It is a white crystalline substance, and 
is prepared in granules which contain gr. 1-67, 
grm. 001. Agaricin is used solely because of 
its action upon the sweat glands. 

Atropine has held the chief place among 
therapeutic agents as the best remedy to check 
profuse sweating, particularly the night sweats 
which accompany phthisis. 

Atropine, however, occasionally fails to pro- 
duce the desired effect. Agaricin has lately re- 
placed atropine, and has frequently cured the 
patient of sweating where atropine has proved 
useless. The custom is to try atropine first; if 
the sweating does not cease, agaricin is adminis- 
tered. It should be given in doses of four 
granules at bedtime and if the patient is awake, 
two granules may be given every two hours dur- 
ing the night. 

This treatment should be continued until the 
sweating ceases, which usually occurs during the 
first week. 



AGARICIN. 39 

Unfortunately, agaricin has also a cathartic 
action which must be carefully watched. If 
diarrhoea is produced, two granules of codeine, 
gr. 1-6 each, should be given with the first 
dose of agaricin at bedtime, or the number of 
granules may be diminished. 

On the whole this may be considered right- 
fully to be the most desirable thing we possess 
for the condition above mentioned. The un- 
pleasant effects often produced by atropine never 
follow the use of agaricin. 



CHAPTER III. 

APOMORPHINE (ARTIFICIAL ALK.). 

Standard granule — Gr. 1-67, grm. .001. 

Dose — As an emetic, six to eight hypodermically or twice 
the number by the mouth. As a relaxant, one or two 
every ten minutes until effect. As an expectorant, two, 
three or four every half to one hour. 

Apomorphine is an "artificial alkaloid," pre- 
pared by heating in a glass tube one part of 
morphine and twenty parts of pure hydrochloric 
acid. The product is subjected to several purify- 
ing processes and is finally crystallized as apo- 
morphine hydrochlorate. 

Apomorphine is prepared in granules which 
contain gr. 1-67, grm. .001. Its properties are 
those of an emetic and expectorant. 

When 1-15 to 1-10 of a grain of apomorphine 
is injected hypodermically, vomiting is usually 
produced in about ten minutes. Very little 
nausea accompanies the emesis and the stomach 
evacuates its contents in two or three efforts. 
Except in cases in which patients manifest 
marked susceptibility to the action of apomor- 
phine, depression does not usually follow its 
administration. 

In an adult suffering from bronchitis, death 
was produced by the hypodermic injection of 
1-15 of a grain of apomorphine. This amount 



APOMORPHINE. 41 

is considered to be a safe dose and it would not 
prove fatal except in cases of debility or in 
those persons who possess an idiosyncrasy against 
its use. 

In other reported cases, in which an alarming 
condition or death was produced, the doses 
were excessively large. 

In spite of the fact that apomorphine has 
produced serious results in several cases, it is 
still regarded, when injected subcutaneously, 
as a gentle, safe, and rapidly acting emetic. 

This remedy does not produce emesis as does 
sulphate of zinc or sulphate of copper, by irri- 
tating the mucous membrane of the stomach but 
by its action upon the spinal nerve centers. 

" That its operation does not result from 
elimination through the gastric mucous membrane 
is proved by the fact that intravenous injection 
is followed by vomiting, in animals whose aortae 
have been previously ligated, so that no apomor- 
phine could be conveyed to the stomach." 
— Nichols. 

This remedy should be given, therefore, when 
an emetic is indicated in inflammatory diseases 
of the stomach. Apomorphine is chiefly used, 
however, in cases of poisoning, especially when 
narcotics have been taken in lethal doses and 
coma has been produced. 

The inability to swallow, because of the coma, 
calls for some rapidly acting and effective emetic 
which can be given hypodermically. This 



42 APOMORPHINE. 

remedy is also of great value when suicide has 
been attempted by taking poison and the person 
refuses to take an antidote. 

If the hypodermic use of apomorphine were 
solely confined to the treatment of cases of 
poisoning, alarming symptoms and death would 
rarely result from its use. But when it is given 
in cases of capillary bronchitis, which generally 
occur in infants and in the aged, a class of 
patients usually unable to offer much resistance, 
great depression and collapse may be expected. 
In capillary bronchitis the internal administra- 
tion of apomorphine, combined with various 
other remedies, is not only more efficacious 
than the hypodermic use but freer from harmful 
results. 

When apomorphine is given hypodermically, 
from one-fifteenth to one-twelfth of a grain is 
the usual dose, which may be repeated at the 
end of twenty minutes if no effect has been pro- 
duced. 

It is always advisable to have at hand a few 
tablets of apomorphine for hypodermic use in 
cases of poisoning. Those physicians who 
practice in places where medicines are not quickly 
obtained and where stomach-pumps are rare, 
should be particularly careful to be provided in 
this way. 

J. S. Horsely reports a case of strychnine 
poisoning, in which doses of about 1-12 of a 
grain of apomorphine not only controlled the 



APOMORPHINE. 43 

convulsions but eventually cured the case. 
The same gentleman reports cases of spasms 
in children which were also cured by injections of 
apomorphine. 

Not only is apomorphine an efficient emetic 
but it has also proved to be an excellent expect- 
orant. When administered in small doses 
frequently repeated, it increases the secretions 
of the mucous membrane of the entire respiratory 
tract. 

This remedy is indicated, therefore, in all 
cases in which the cough is dry or the sputum 
is tough. It is of especial value in two dreaded 
diseases, in acute laryngitis and in capillary 
bronchitis. The writer had never found a satis- 
factory remedy in the treatment of this latter 
disease until he began to use apomorphine; 
since which time he no longer dreads to meet 
this formidable disease. Success in the treat- 
ment of capillary bronchitis depends upon the 
frequent administration of small doses of apo- 
morphine, together with strychnine, throughout 
the course of the disease. Strychnine is given 
to stimulate the vital functions and to prevent 
paralysis. 

The danger in capillary bronchitis is carbonic 
acid gas poisoning, followed by paralysis. By 
the early use of strychnine the nerve centers of 
respiration and of cardiac movement are stimu- 
lated, so as to resist, for a time at least, carbonic 
acid poisoning. 



44 APOMORPHINE. 

Meanwhile apomorphine, which has also been 
given in conjunction with strychnine, causes a 
bronchial secretion to be formed, that not only 
loosens the plugs of tenacious material which 
are occluding the bronchioles but, by the 
exudation of this thin secretion, depletes the 
swollen mucous membrane. The obstruction is 
removed and again air passes freely into the 
alveoli; this permits oxidation of haemoglobin 
and elimination of carbonic acid gas. 

Strychnine also aids the expectorant quality 
of apomorphine by increasing the irritability 
and contractility of those muscles which have 
as a part of their function the expulsion of mu- 
cus; and it also improves the tone of the entire 
muscular system. The more debilitated the 
patient, whether infantile or aged, the more 
urgent is the demand for strychnine. 

It is absolutely wrong to wait before admin- 
istering strychnine until symptoms of paralysis 
appear, as manifested by the abdominal muscles, 
at their attachment to the costal cartilages, be- 
ing drawn in during each inspiration. It is our 
duty to determine, if possible, the dangerous 
tendencies of every disease and, by the admin- 
istration of properly selected remedies, to strive 
to prevent them. 

To wait until dangerous symptoms appear is an 
irreparable loss of valuable time. Experience 
should teach us that certain tendencies are 
likely to occur during the course of certain 



APOMORPHINE. 45 

diseases. It seems reasonable that, if we fortify 
the patient properly against these harmful ten- 
dencies, they must be only slightly injurious or 
may be completely averted. 

Not only in capillary bronchitis but in the 
bronchitis of the larger tubes, apomorphine is 
a valuable remedy. It may be given even to 
debilitated phthisical patients. If a stimulating 
action is required, monobromated camphor may 
be given in conjunction with apomorphine; if an 
anodyne action is required to relieve painful and 
harassing cough, codeine and apomorphine 
make an excellent combination. 

In the treatment of croup, apomorphine 
should be the first remedy given. The dry 
harsh cough and the accompanying dyspnoea are 
relieved without the necessity of producing nau- 
sea or vomiting. As suggested by Dr. Abbott, 
apomorphine, hyoscyamine and strychnine form 
an excellent combination from which good 
results may be obtained. 

Formerly, when urgent symptoms were man- 
ifested in croup, Turpeth's mineral was the 
sheet anchor of the physician. Now, apomor- 
phine in small doses repeated every fifteen min- 
utes brings relief gradually, surely, and harm- 
lessly. Can we say as much of Turpeth's 
mineral? 

To illustrate the efficacy of apomorphine the 
following case of croup is given. The patient 
was a boy of five years. Besides the constant 



46 APOMORPHINE. 

croupy cough, there were marked dyspnoea and 
restlessness, the pulse was 160, the tempera- 
ture was 103 degrees and the respirations were 
58. The treatment was as follows: 

Thirty-six granules of apomorphine and six 
granules of Dosimetric Trinity No. 1, were dis- 
solved in twenty-four teaspoonfuls of water. 
Of this mixture, one teaspoonful was ordered 
to be given every fifteen minutes until the breath- 
ing became easier, after which the same amount 
was to be given every half hour. The patient 
was seen again six hours later and was found 
to be in the following condition: The temper- 
ature was 100 degrees, the pulse was 150 and 
stronger than before, the. respirations were 42. 
The medicine was ordered to be given every 
hour. Improvement continued, and within a 
few days the patient was well. In another se- 
vere case of laryngitis, which occured during an 
attack of measles, in the case of a boy of seven 
years, intubation was thought necessary, but 
postponed, and apomorphine in doses of gr. 
1-48, was given every fifteen minutes. Im- 
provement began after several doses had been 
given, the cough grew looser, the breathing be- 
came easier and remained so during the con- 
tinuance of the measles. 

When apomorphine is indicated in inflamma- 
tory diseases of the bronchi and fever is pres- 
ent, aconitine should always be given in combi- 
nation with it. If cough is troublesome and is 



APOMORPHINE. 



47 



not reduced by the increased flow of mucus, co- 
deine or hyoscyamine may be given with apo- 
morphine. 

When a solution of apomorphine is first made 
it is perfectly clear; after awhile, however, it be- 
comes green from oxidation but this does not 
interfere with its excellent expectorant qualities. 
In all diseases of the respiratory tract, where 
ipecacuanha or its alkaloid emetine is indicated, 
this remedy may be used with better re- 
sults and without dangerous consequences. 

The dose of apomorphine as an expectorant 
for adults is two, three, or four granules every 
half hour or every hour. 

A child of six years old readily bears one 
granule, so that in preparing a solution, twenty- 
four granules may be dissolved in twenty-four 
teaspoonfuls of water. 

For a child of 6 years, dissolve 24 granules in 
24 teaspoonfuls of water. 

For a child of 4 years, dissolve 18 granules in 
24 teaspoonfuls of water. 

For a child of 2 years, dissolve 12 granules in 
24 teaspoonfuls of water. 

For a child of 1 year, dissolve 6 granules in 
24 teaspoonfuls of water. 

An infant may be given one-half teaspoonful 
of the solution prepared for the one year old child. 
If improvement does not follow within three to 
five hours the dose in each case may be 
increased. 



CHAPTER IV. 

ARBUTIN (GLU.)- 

Standard granule — Gr. 1-67, grm. .001. 
Dose — One every fifteen to thirty minutes till effect and 
then as needed to sustain the same. 

This principle is present in quite a number of 
what we call diuretic plants — chimaphila, gaul- 
theria, uva ursi, trailing arbutus, etc. In large 
doses it is a drastic cathartic, also an irritant to 
the kidneys as well, while in small • doses it is 
a gentle stimulant to urinary secretion. It is an 
elegant diuretic, soothing the whole urinary 
tract, and stimulating a good flow of normal 
urine. 

It is almost tasteless in properly dilute solution, 
and should always be given in this way, or fol- 
lowed with a free drink of water. It is particu- 
larly nice in the treatment of children, no matter 
how young, to whom it is difficult to give the 
rank-tasting diuretics so long in use. In the 
enuria of the new born it works like a charm. 
The ordinary rules of dosage of course apply. 



CHAPTER V. 

ASP AR AGIN (GLY.). 

Standard granule — Gr. 1-67. 

Dose — Four granules every 1-2 to 1 or 2 hours as needed. 

Asparaginis a crystallizable, organic princi- 
ple, prepared chiefly from the fresh sprouts of 
the common garden asparagus. The part of this 
plant, which is very frequently and erroneously 
used in domestic practice, is the root. While 
this contains glucose, extractives and other con- 
stituents, it contains little asparagin. 

In w ' Dosimetry, "asparagin is prepared in gran- 
ules each containing gr. 1-67. It is not poison- 
ous and can be given in doses of from one to 
three grains without producing injurious 
results. 

Formerly, when a patient presented himself 
with acute or chronic inflammation of the bladder, 
buchu, hyoscyamus and acetate of potash were 
the remedies usually prescribed and they are 
still used by many physicians who adhere to the 
older method of administering crude drugs. 
The combination is not without virtue but its 
taste and odor is disagreeable. In alkaloidal 
medication asparagin replaces the buchu of the 
older practice. It is tasteless, a quality appre- 
ciated not only by children, but also by adults. 
Asparagin has a soothing effect similar to that of 



50 ASPARAGIN. 

buchu, upon the inflamed and irritated mucous 
membrane of the entire urinary tract. 

It acts as an alterative upon the glands of the 
mucous membrane of the urinary organs, re- 
storing them to their normal functions, dimin- 
ishing the amounJ^tna\ch#nging the character 
of the mucus and, thereby, allaying inflammation. 
Before a prescription is made for a case of 
cystitis it is absolutely necessary to discover 
the cause of the disease. 

Beneficial results cannot follow medical 
treatment when surgical means are necessary 
to remove the cause. 

Among the chief causes of irritation and in- 
flammation of the bladder, are the following 
In the male, calculi, enlarged prostate gland 
and gonorrhoea; in the female, uterine displace- 
ment and urethral caruncles. After a careful 
examination and the exclusion of all surround- 
ing structures and organs as causes in the pro- 
duction of vesical irritation, if inflammation of 
the mucous membrane alone remains, asparagin is 
the remedy indicated. 

If cystitis is traumatic or symptomatic in its 
origin and the cause has been removed and 
there remains an irritable condition of the blad- 
der, asparagin is still the medicine to be admin- 
istered. It may be given alone in doses of 
four granules every half-hour or every hour for 
adults but, for children three or four years of 
age, one granule every hour will be sufficient. 



ASPARAGIN. 51 

When pain and tenesmus are pronounced, 
with frequent desire to urinate and with scald- 
ing sensation along the urethral tract, my 
favorite prescription, from the use of which 
I have obtained excellent results, is asparagin 48 
granules, hyoscyamine 24 granules, lithuim 
benzoate 48 granules. Dissolve these gran- 
ules in a three-ounce bottle or in twenty- 
four teaspoonfuls of water ancj of this mixture 
order a teaspoonful to be taken every half hour 
or every hour. 

If fever is present twenty-four granules of 
aconitine apomorphus should be added to the 
above prescription. 

An important aid in the further treatment of 
cystitis is found in the administration of Saline 
cathartics, as alkaline, effervescent Seidlitz Salt. 

Besides the beneficial effects derived from free 
purgation, the urine is modified in its character 
by the presence of alkaline salts which have 
been eliminated by the kidneys. Litmus paper 
should be frequently used to test the reaction of 
urine. If the urine is ammonical and contains 
ropy mucus, free use should be made of salicy- 
lic, boracic and benzoic acid or the salts of 
benzoic acid, but it is better not to employ 
mineral acids for they have little influence in 
modifying alkaline urine. If the urine shows 
a highly acid reaction, four granules of carbon- 
ate of lithium should be given every hour until 
improvement is manifest. 



CHAPTER VI. 

ATROPINE (ALK.). 

Standard granule — Gr. 1-250, grm. .00025. 

Dose — One to four according to the effect desired. The 
favorable action of minute dosage in some conditions 
should not be forgotten*. 

Atropine is the principle alkaloid of atropa 
belladonna. 

Dosimetric granules of atropine contain 
either 1-250 of a grain or 1-500 of a grain. Pref- 
erence should be given to the use of the sul- 
phate as it is much more soluble than the un- 
combined alkaloid. 

Atropine is a wonderful remedy. It may be 
applied in the treatment of a great variety of 
diseases. 

Of course medicines cannot be intelligently 
and beneficially prescribed without a knowledge 
of their physiological action, and this is particu- 
larly true of atropine. 

Success cannot follow the use of atropine in 
the treatment of disease unless the physician 



^Atropine has a well recognized action in minute dose 
that is directly opposite to its action in the dose usually 
used. In large dose it relaxes while in minute dose, gr. 
1-1000 to gr. 1-3000, it stimulates the vaso-motors to con- 
tract and gives prompt relief in many painful regional 
congestions, notably congestive headaches. — Pub. 



ATROPINE. 53 

knows that it checks secretions, that it relaxes 
spasmodic contractions of voluntary and invol- 
untary muscles, that it stimulates and quickens 
depressed action of the heart and lungs, that it 
primarily contracts and secondarily relaxes the- 
arterioles, augmenting the quantity of blood in 
the integument and, lastly, that it increases the 
temperature of the body. 

No remedy has been so successful in checking 
the " night sweats " in cases of phthisis or the 
general or local sweating accompanying other 
diseases. To overcome local sweating, atropine 
should be locally applied in the proportion of 
two grains to the ounce of water. In the treat- 
ment of night sweats the best results are obtained 
by the administration of a single dose at bed 
time of from two to four granules, each contain- 
ing 1-250 of a grain. 

The profuse watery discharge from the- eyes 
and nose during an attack of acute coryza is 
frequently relieved by a single dose of two or 
three granules (1-250 of a grain each) or by the 
administration of one of these granules every 
half hour until the desired result is obtained. 
Ptyalism, whether produced by mercurial or 
other forms of stomatitis, or occurring during 
pregnancy, is rapidly checked by the use of 
atropine. In order to obtain the best results 
with this remedy in the treatment of diseases of 
the respiratory tract, we should prescribe it only 
in those cases where there is free secretion. The 



54 ATROPINE. 

paroxysms of asthma are frequently relieved 
with surprising rapidity when atropine is given 
hypodermically. It may also be given intern- 
ally, or the same result may be obtained by 
smoking belladonna leaves and inhaling the 
smoke. In the treatment of asthma, Bartholow 
says, " When the skin is dry and hot, and the 
bronchial secretion scanty and the pulse is much 
accelerated, atropine adds to the distress." In 
the treatment of whooping cough, wonderful 
results are frequently obtained by the use of 
this remedy. The best way to give atropine in 
this disease is in doses sufficiently large to pro- 
duce physiological effects which are manifested 
by dryness of the mouth and throat, dilation of 
the pupil and redness of the skin. Two doses 
should be given daily, one before breakfast and 
the other at bedtime. As soon as the physio- 
logical effects of atropine are manifested, the 
number and severity of the paroxysms are 
rapidly diminished. The way to prescribe 
atropine for children is to dissolve in twenty- 
four teaspoonfuls of water, one granule ( 1-250 
of a grain ) for each year of the patient's age 
with one additional granule. Of this solution a 
teaspoonful should be given morning and even- 
ing. If physiological effects are not produced, 
an additional granule should be added to the 
original prescription; if there are still no results, 
two granules may be added next day, three ad- 
ditional granules the next day and so on 



ATROPINE. 55 

until some effect is produced. When the physi- 
ological dose is determined in this manner it 
should be continued until there is a decided im- 
provement. 

Another method is to give a teaspoonful of the 
original prescription every half hour until the 
mouth becomes dry, which will be manifested 
by a desire to drink frequently, or may be dis- 
covered by inspection. But the latter method 
should be employed only once daily throughout 
the spasmodic stage of whooping cough. 

Atropine primarily increases the number of 
pulsations and respirations, together with the 
temperature of the body. Bolles gives the follow- 
ing indications for its use: "In excessive col- 
lapse with failing pulse and respiration, with 
reduction of temperature and cold perspiration, 
life is in danger and atropine may be the means 
of saving it. There is no other remedy which 
so completely antagonizes these symptoms." 
Hare says: "If symptoms of collapse come on — 
and they should be anticipated in the old or 
cachetic persons and young children — a hypo- 
dermic injection of 1-60 to 1-30 of a grain will be 
most effective to prevent it." 

Congestive chills can be prevented by taking 
three or four granules of atropine ( 1-250 of a 
grain each ) one hour before the time of the ex- 
pected chill. Even during a chill atropine may 
be given with the assurance of shortening its 
duration. In the treatment of internal hemor- 



56 ATROPINE. 

rhages, the use of atropine is much neglected. 
In recurrent pulmonary hemorrhages, the bleed- 
ing may be prevented by anticipating the attack 
by a hypodermic injection of 1-80 of a grain, or 
four granules of atropine may be given internally. 
In menorrhagia or metrorrhagia and haematuria, 
when other remedies have failed, this remedy 
frequently effects a cure, when a cure can be 
affected by medicines alone. 

Atropine reduces contractions of voluntary 
and involuntary muscles and is indicated there- 
fore in rigidity of the os uteri during labor, in 
tenesmus of the bladder and rectum, in stomachic, 
intestinal, hepatic and renal colic. In torticollis 
or in spasm of single muscles, atropine should 
be administerd hypodermically into the muscle 
affected. 

In the treatment of incontinence of urine, 
no remedy produces results so satisfactory 
as those obtained by the use of atropine. It is 
particularly indicated where the mucous mem- 
brane of the bladder is sensitive. In treating 
nocturnal incontinence either a single large dose 
of the medicine should be given at bedtime, or 
preferably a number of small doses ( according 
to the method of treating whooping cough ) 
every half hour until dryness of the mouth is 
produced. The kidneys eliminate atropine from 
the blood, and by its presence in the urine it 
locally relieves the sensitive mucous membrane 
which is irritated by the presence of small 



ATROPINE. 57 

quantities of urine and produces frequent and 
uncontrollable expulsions. 

Hypodermic injections of atropine ( 1-60 of a 
grain) at the seat of pain often cure sciatica and 
facial neuralgia. 

Dysmenorrhcea and ovarian pains are also 
controlled by the internal use of the medicine. 
Migraine is often cut short, especially if the 
remedy can be given in anticipation of the attack. 

Atropine never should be given to nursing 
women because of its power to arrest the secre- 
tion of milk. When it is necessary to check the 
functions of the mammary gland, it maybe given 
internally or applied externally to the gland. 
Three grains to the ounce of water is sufficiently 
strong, and the remedy is best applied by wet- 
ting strips of old linen with the solution and lay- 
ing them on the breast; when dryness of the mouth 
is observed, the cloth should be removed, 
because this indicates that the physiological 
effect has been attained, and it is never safe 
to pass beyond the physiological limit of any 
medicine. 

Atropine is directly antagonistic to the action 
of pilocarpine; each remedy can therefore be 
used as an antidote to overcome the evil effects 
of the other. In opium poisoning the best 
physiological antidote is atropine. As atropine 
increases peristalsis and prevents the griping 
produced by the action of cathartics, it is im- 
portant as an aid to this class of medicines. 



58 ATROPINE. 

The dilation of the pupil, produced when the 
solution of atropine is dropped into the eye, is 
of great value in preventing adhesion and hernia 
of the iris, in relieving intra-ocular pressure and 
in reducing inflammation of the iris, also in 
permitting opthalmoscopic examinations to be 
easily made. 

Primarily, atropine contracts and secondarily 
relaxes the arterioles. The augmented pressure 
which at first occurs relieves congestion and in- 
creases arterial and capillary circulation and the 
quantity of blood in the integument. This 
action is utilized in the treatment of those 
diseases which involve the skin, as erysipelas, 
scarlet fever and neurosis. When depression is 
present in erysipelas and scarlet fever and the 
eruption is ill defined or tardy, atropine changes 
the character of the eruption and very materially 
improves the condition of the patient. This 
primary action of atropine is also utilized in the 
treatment of congestions and hemorrhages. 
A single dose of three or four granules should be 
given as early as possible. When indications 
are present which require the use of atropine 
and there is doubt regarding the susceptibility 
of the patient to the action of this remedy, or 
from whatever cause hesitancy exists in regard 
to its administration, the following plan should 
be followed as one from which no possible harm 
can result. One granule (1-250 of a grain) 
should be given every half hour to adults until 



ATROPINE. 59 

there is dryness in the mouth and throat. By 
this time beneficial results are frequently mani- 
fested in acute cases. If more prolonged action 
is deemed necessary, one granule should be taken 
every two or three hours. This method can be 
employed in the treatment of all cases where 
atropine is indicated, but sometimes better 
results are obtained by a single large dose, in 
cases of emergency, as in congestive chills, 
hemorrhages and shocks. When atropine, or 
any other medicine is administered in small and 
frequently repeated doses, the effect is gradual, 
and when the results are obtained, the medicine 
is given at greater intervals, or is withdrawm 
altogether. It is impossible to know how much 
of any remedy will be needed to overcome a 
disease or remove a symptom. Undesirable 
results are more likely to follow a single large 
dose, than small doses frequently repeated. 
This latter method is preferable when prescrib- 
ing atropine for blondes. They are more sus- 
ceptible than brunettes to its action. The red- 
ness of the skin ( which is secondary ) frequently 
follows small doses of this drug and is most 
marked in those who have light complexions. 

Children bear atropine proportionally better 
than adults. While atropine can be given in 
doses of i -20 of a grain without very serious 
results, the aim should be always to use as small 
a dose as will alleviate the symptoms and cure 
the disease. Atropine in doses of i-ioof a grain 



60 ATROPINE. 

administered to adults would probably cause 
death in the majority of cases. There would be 
produced increase of the pulse rate and respira- 
tions, active talkative delirium, convulsions, 
stupor and paralysis. In dosimetric medication, 
poisoning cannot occur if minimum doses are 
given according to the rules formulated. 
Except in cases of collapse, as in chloroform 
narcosis, opium poisoning or extreme shock, 
1-60 of a grain of atropine should be exceeded 
only after full consideration of all the circum- 
stances connected with the case. 



^*o^* 



CHAPTER VII. 
BRYONIN (GLU.). 

Standard Granule — Gr. 1-67, grm. .001. 
Dose — Two every two hours until effect, then one gran- 
ule every two or three hours to sustain the same. 

Bryonia Alba contains bryonin, a glucoside, 
and bryonidine, an alkaloid. It was discovered 
by WaJz in 1859. Bryonin is used medicinally 
in preference to bryonidine because of its milder 
action. The latter is a decided irritant to the 
mucous membrane of the gastro-intestinal canal. 
In sufficiently large doses, even bryonin is 
a powerful hydrogogue cathartic. It also stim- 
ulates the kidneys and thus increases the quantity 
of urine. 

The indications for its use are therefore plain. 
In all cases of dropsy, whether of the serous 
cavities or of the cellular tissues, the absorption 
of the effused fluid is successfully accomplished 
by the use of bryonin. In relieving torpidity or 
congestion of the liver and so-called "bilious- 
ness," bryonin is a remedy of value 

As a result of the inflammation of serous 
membranes, after fever has been reduced by 
aconitine, there frequently remain various pain- 
ful and annoying conditions which may continue 
for years; e. g., the severe headaches which oc- 
cur after an attack of meningitis; the "stitch in 



62 BRYONIN, 

the side" which follows pleurisy; the precor- 
dial pain of chronic pericarditis and the pain and 
stiffness of joints which remain after an attack 
of rheumatism, are all relieved and frequently 
cured by the administration of bryonin. The 
principal use, indeed, of bryonin is in the allevi- 
ation and cure of chronic inflammations of serous 
membranes. After a decided physiological im- 
pression has been made with the drug, beneficial 
results are more rapidly and effectually produced 
by its subsequent use. 

Two granules, each containing gr. 1-67, should 
therefore be given every two hours until the 
bowels are thoroughly evacuated, after which 
one granule may be given every two or three 
hours. If the patient is robust, and is habitually 
constipated, the dose may be increased by one 
or two additional granules, but if the patient 
is delicate and the bowels respond quickly to the 
action of cathartics, the dose should be reduced. 
If bryonin produces pain, a granule of atropine 
or hyoscyamine should be added to each dose. 
To effect a cure in chronic inflammations of the 
serous membranes, several weeks of continuous 
treatment may be required.* 

Success follows the treatment of chronic dis- 
eases only after perseverance in the use of prop- 
erly selected remedies. The rule is not to 
change medicines often when treating chronic 
cases — to oppose to chronic diseases chronic 
treatment. * 



CHAPTER VIII. 

"CARDIAC TONIC."* 

THE ACTIVE PRINCIPLE OF CACTUS GRANDIFLORA. 

Standard granule — Gr. 1-134, grm. .0005. 
Dose — One or two granules every hour or two accord- 
ing to the necessities of the case. 

The active principle of Cactus Grandiflora, 
or Night-blooming Cereus, is a valuable remedy. 
In dosimetric practice, it is used in granules as 
above. It is a cardiac stimulant and is of 
special value in the treatment of functional de- 
rangement of the heart. In palpitation connected 
with dyspnoea, sexual excesses, nervous disorders, 
muscular and mental exhaustion, excessive use 
of tobacco, tea and coffee it has proved to be a 
very useful remedy. 

It decreases the heart's action and increases 
the blood-pressure but it does not produce such 
vigorous contractions as does digitalin. Accord- 
ing to P. W. Williams it shortens the diastole 
and is, therefore, contra-indicated in mitral sten- 
osis, but it is especially indicated in aortic re- 
gurgitation. When dyspnoea and oedema are 
produced by cardiac diseases, it frequently gives 
great relief. It is a safe remedy, free from cumu- 
lative action; it increases the appetite and may 
be used whenever digitalin fails to effect a cure 
or where the latter disagrees with the patient. 

*A word approximating to the right name of this active 
principle is copyrighted, hence the above fantastic caption. 



CHAPTER IX. 

CAFFEINE (ALK). 

Standard granule — Gr. 1-6, grm. .01. 
Dose — Two to four every 1-2 to two hours according 
to effect desired. For children gr. 1-67 is best used. 

Caffeine is an alkaloid obtained from coffee, 
from tea leaves and various other plants. It is 
distinguished from all other alkaloids by the 
large amount of nitrogen which it contains. Its 
physiological action is similar to digitalin and 
it may be used whenever the latter is indicated. 
The remarkable quickness with which results are 
produced by the use of this drug gives it a 
decided advantage over digitalin. It increases the 
blood-pressure, lessens the pulsations of the 
heart and augments the quantity of urine 
excreted. As a means, therefore, of reducing 
dropsical effusions caffeine may be successfully 
used. 

When, during typhoid fever, pneumonia or 
other serious diseases, the heart shows signs of 
failing and the pulse is feeble and easily com- 
pressed, caffeine should be given daily instead 
of alcohol. It sustains the heart's action and 
stimulates the nerve centers. In cases of col- 
lapse, shock or syncope, hypodermic injections 
of caffeine gr. 1 should be administered. When 



CAFFEINE. 65 

there is a tendency on the part of the patient to 
become drowsy or comatosed, caffeine can be 
used to induce wakefulness. If the pulse is fre- 
quent and feeble and the secretion of urine 
scanty or suppressed, this remedy increases the 
strength of the heart, reduces the number of its 
pulsations and re-establishes the urinary secre- 
tion. 

In the treatment of dropsical effusions, caffeine 
should always be tried, especially if digitalin 
fails, or it may be combined with digitalin. The 
increase of the amount of urine does not depend 
entirely upon the increase of blood-pressure but 
also upon the action which caffeine exercises in 
stimulating the rodded cells of the uriniferous 
tubules. 

Caffeine is very frequently used in the treat- 
ment of headaches, especially when resulting 
from overwork or worry. In prescribing for 
adults caffeine granules containing 1-6 of a grain 
should be used, while in the treatment of children 
granules containing 1-67 will generally produce 
the desired result. Two, three or four granules 
may be given every half hour when the 
object is to relieve headache or the acute sup- 
pression of the urine. In dropsy, or in diseases 
of the heart nor requiring immediate relief, four 
or five granules should be given every two or 
three hours. In cases of emergency, as in 
syncope, collapse or coma, a grain may be given 
hypodermically. Caffeine is an alkaloid pos- 



66 CAFFEINE. 

sessing no very marked poisoDOus properties and 
when it is indicated, and relief does not follow 
its administration in small quantities, the 
dose may be increased to three or four grains. 

When the brain or the muscular system is 
exhausted, and food, rest and sleep are required, 
especially if additional demands for work seem 
imperative, man resorts only too often to the 
use of alcoholics. Stimulants are used to whip 
up tired Nature to compel her to yield still more 
energy; but alcohol ought not to be used in this 
way to stimulate the already overtaxed brain and 
muscles with the hope that somewhere there exists 
latent strength which can be called forth on de- 
mand; this use of alcohol is seductive, injurious 
and fallacious. Leaving out of consideration 
the omnipresent danger of acquiring the alcohol 
habit, those who possess a knowledge of the 
physiological action and chemistry of the reme- 
dials must find caffeine pre-eminently more effec- 
tive than alcohol as a stimulant to the heart, 
brain and muscle while at the same time its use 
is totally devoid of danger except that, possibly, 
of overstimulating the heart. Used properly, 
it st rengthens the heart's action, increases mental 
activity and relieves muscular fatigue. 






CHAPTER X. 

CALCIUM SULPHIDE. 

Standard granule — Gr. 1-6, grm. .01. 
Dose — One to three or four granules every half hour, or 
every one or two hours. 

Calcium sulphide, so called, is a mixture of 
sulphate of calcium with not less than 36 per 
cent of sulphide of calcium. This remedy is 
therefore a sulphuretted lime. When calcium 
sulphide is taken internally, the patient's breath 
emits the disagreeable odor of sulphuretted 
hydrogen and eructations of the same gas also 
occur. 

It is thus clearly demonstrated that this salt is 
decomposed within the body, and that sulphate 
of lime and sulphuretted hydrogen are formed. 

The sulphate of lime is insoluble and passes 
out with the feces, and the sulphuretted hydrogen 
is absorbed into the blood and eliminated by 
means of the skin and lungs. 

Because of the elimination of sulphuretted 
hydrogen from the blood by the lungs, calcium 
sulphide produces excellent results when used 
in the treatment of diseases of the bronchial 
tubes. Sulphuretted hydrogen is thus brought 
into contact with the glands of the respiratory 
mucous membrane and stimulates them. 



68 CALCIUM SULPHIDE. 

In all catarrhal diseases of the lungs where the 
sputum is scanty or tough, in measles and per- 
tussis where the cough is distressing, in chronic 
diseases of the lungs where the expectoration is 
in a state of putrescense, the character of the mu- 
cus is materially changed, and the distressing 
cough is relieved, by the administration of cal- 
cium sulphide. 

Through the researches of Ringer and Murrell 
it was learned that calcium sulphide possesses 
the property of preventing and aborting boils, 
particularly when they occur in successive 
" crops." 

This remedy is frequently used to reduce in- 
flammation and check suppuration of the lym- 
phatic glands, and every indication tends to show 
that it will prove a valuable remedy in the treat- 
ment of carbuncles. In prescribing for patients 
afflicted with these diseases, two or three gran- 
ules, each containing 1-6 of a grain, should be 
given every one, two or three hours, according 
to the severity of the attack. 

A most important application of sulphide of 
calcium is in the treatment of zymotic diseases. 

Measels, whooping-cough, scarlet fever, small- 
pox, diphtheria and erysipelas are all more easily 
controlled, and are freer from sequelae when this 
remedy is used than when other agents are 
employed. Calcium sulphide should be given 
throughout the entire course of these diseases. 

If complications arise, this remedy should still 



CALCIUM SULPHIDE. 69 

be continued, either alone or in combination with 
those remedies which are required to meet the 
new conditions. 

When fever is present, aconitine should be 
given. When there are tendencies tow T ard col- 
lapse and signs of heart failure, caffeine is the 
remedy indicated; when the danger is paralysis, 
as in diphtheria, strychnine should be admin- 
istered. When the throat is inflamed, and is 
the seat of ulceration, or of diphtheric deposits, 
it is best to give calcium sulphide in solution. 

In severe cases the remedy should be given 
ever}' fifteen minutes. By its frequent adminis- 
tration in throat diseases, the solution of cal- 
cium sulphide almost constantly bathes the in- 
flamed and infected mucous membrane, and aids 
in bringing about a speedy cure. 

The septic materials produced by the various 
bacilli of zymotic diseases are probably neutral- 
ized by the presence of sulphuretted hydrogen 
in the blood. Physicians who have used calcium 
sulphide in the treatment of infectious diseases 
testify to its wonderful efficacy in preventing or 
counteracting septic infection. 

Calcium sulphide produces good results, not 
by destroying bacilli ( a belief which seems to 
prevail among those who practice dosimetry), 
but by neutralizing poisons which are produced 
by them. Further, the action of this medicine 
upon the glandular structures of the respiratory 
and intestinal tracts produces an increase of the 



70 CALCIUM SULPHIDE. 

secretions and in this way eliminates morbid 
materials from the blood. 

It is said that anemia is produced by the dis- 
integration of the red blood corpuscles through 
long continued action of sulphides. This action 
of calcium sulphide need not be considered in the 
treatment of acute infectious diseases (except in 
pertussis) because of their short duration. 

Unless calcium sulphide is taken continuously 
for four or five weeks anemia can rarely be pro- 
duced. In the treatment of whooping-cough 
the writer has frequently given calcium sulphide 
continuously for three or four weeks, always with 
marked reduction in the number and severity of 
the paroxysms, but he has never seen anemia fol- 
low its use. If, however, anemia exists, or if its 
occurrence seems probable, one or two granules 
of arseniate of iron should be given with each 
meal. 

It is important to remember that a fresh solu- 
tion of sulphide of calcium should be prepared 
daily and kept in a well corked bottle. 
Free access of oxygen decomposes the medi- 
cine, a disagreeable odor of sulphuretted hydro- 
gen is emitted, and, besides this, the ther- 
apeutic quality of the solution is destroyed. 

It is best to measure the doses in a medicine 
glass, for metal spoons are blackened by con- 
tact with calcium sulphide, and this frequently 
conveys the impression that the medicine must 
be unusually strong to produce such an effect. 



CALCIUM SULPHIDE. 71 

If a spoon is used it should not be allowed to 
remain in the solution, and an explanation of 
the discoloration ought to be given, with the as- 
surance that no harm can result to the patient. 

Calcium sulphide is a harmless remedy, and 
can be given in doses of four or five grains with- 
out injury. 

In treating adults for erysipelas or for chronic 
lung diseases where the object is to overcome the 
offensiveness of the sputum or to reduce the ten- 
acity of the mucus, two or three granules (1-6 
of a grain each) of calcium sulphide may be 
given every one, two or three hours. 

In the treatment of whooping-cough a dose 
should be given every two or three hours. To 
infants one year old, eight or ten granules should 
be dissolved in a three ounce vial and a tea- 
spoonful of the solution should be administered 
every two or three hours. To children from two 
to five years of age, a single granule may be 
given as a dose. To patients from five to ten 
years of age, one or two granules given every 
two hours is a proper dose. 

It will be found that those who will swallow 
the granules do not tire of the medicine so 
quickly as when it is given in solution. 

In all cases where the eructations of sulphur- 
etted hydrogen gas are excessive, or are com- 
plained of, the dose should be diminished and 
given, preferably, before meals when there is no 
acid in the stomach, for the acid of the gastric 
juice readily decomposes calcium sulphide. 



CHAPTER XL 
CONIINE HYDROBROMATE. 

Standard granule — Gr. 1-67, grm. .001. 

Dose — One, two or three every half to one hour. 

Coniine or conine is a valuable alkaloid, ob- 
tained from the leaves and fruit of conium raac- 
ulatum or spotted hemlock. Cicutine, which is 
obtained from the herb cicuta virosa, or water 
hemlock, is also a valuable alkaloid, and by 
some authorities is said to be the same as co- 
niine. 

Bartholow says: " The action of coniine is pri- 
marily and chiefly on the end-organs of the 
motor nerves. When an active dose of coniine 
is administered, weakness of the legs and a sense 
of weight and fatigue of these members is first 
experienced. The eyelids become heavy and 
droop somewhat and double or confused vision, 
a feeling of torpor of the mind, and giddiness 
follow." Harley says: "The whole muscular 
system is completely relaxed. " 

Coniine is indicated, therefore, in all cases of 
exalted muscular movement, in spasmodic action 
of muscles such as occur in asthma, chorea, epi- 
lepsy, tetanus and hydrophobia. Coniine has 
also been used successfully in the treatment of the 



CONIINE HYDROBROMATE. jZ 

neuralgia and cancer, especially uterine cancer*. 
Hydrobromate of coniine is undoubtedly the 
best preparation, and the dose ranges from 1-30 
to 1-15 of a grain. In the treatment of adults, 
one, two or three granules should be given every 
hour until there is some relief, or until there 
is a sense of weight or heaviness of the legs 
or eyelids. The dose should then be given 
every three or four hours, in order to keep the 
patient under the influence of the remedy. 

In cases in which the symptoms are severe 
and the demand is urgent, two or three gran- 
ules may be administered hypodermically, 
as often as every hour, until there are some 
evidences of the effect of the medicine. In 
the treatment of children, one or two granules 
for each year of the patient's age should be dis- 
solved in twenty-four teaspoonfuls of water, and 
a teaspoonful should be given every hour or 
every two hours according to the urgency of 
the case. Coniine is a very useful remedy in re- 
ducing the number and the severity of the par- 
oxysms of coughing in whooping-cough. 

*The author calls your attention to the power of this 
drug over neuralgia, particularly that of uterine cancer. 
It is our opinion that the effect of coniine on the sensory 
nerves is not sufficiently well understood. This is partic- 
ularly manifest when very small doses are used. Small doses 
affect the sensory terminal before the motor terminals are in- 
fluenced. We desire particularly to emphasize its useful- 
ness in the pains and backache of menstruation, especially 
functional dysmenorrhcea. One granule every fifteen to 
thirty minutes until relief is obtained. — Pub. 



CHAPTER XII. 

COLCHICINE (ALK). 

Standard granule — Gr. 1-134, grm. .0005. 

Dose — One or two every 1-2 to two hours till effect. 

Colchicine is the alkaloid of colchicum autum- 
nale, or meadow saffron, and is prepared in 
granules containing gr. 1-134 grm. .0005. The 
medicinal virtue of the tincture, extract and wine 
of colchicum is due to the effect of the active prin- 
ciple colchicine. The physiological action of 
colchicine depends upon the number of granules 
given and upon the frequency of their admin- 
istration. By giving one or two granules every 
two hours the activity of the skin and kidneys is 
increased and, in some susceptible patients, 
catharsis is produced, after eight or ten granules 
have been administered. 

After one or more doses of three or four granules, 
given every hour, severe diarrhoea and usually 
vomiting occur. Larger amounts would produce 
violent gastro-intestinal irritation and inflamma- 
tion, which might terminate in death. 

Two granules at a time, therefore, should 
never be exceeded, unless experience shows, 
that, in a particular case, desired effects cannot 
be produced without increasing the dose. Bile is 



COLCHICINE. 75 

always present in the evacuations produced by 
colchicine and, as this remedy is successfully 
used in the treatment of hepatic congestion, it 
evidently increases the activity of the liver. 

Colchicine not only increases the secretion of 
the liver but also of the intestines, skin and 
kidneys. Its effect is to eliminate urea and uric 
acid. This clearly demonstrates the usefulness 
of colchicine in the treatment of gout and rheu- 
matism, which are produced by an accumulation 
in the blood of uric acid and urea, and by a 
deposit of these substances in various tissues. 
In the treatment of gout, colchicine is almost 
a specific; while in acute, articular rheumatism 
it has proved itself to be as efficacious, in some 
cases, as salicylic acid if not more so. 

In cases of acute gout and in acute rheuma- 
tism the treatment is the same. If fever exists 
one granule each of aconitine and colchicine 
should be given every half hour, or every hour, 
until the patient is relieved of pain. The dose 
may then be given every two hours. If the 
pains are excessive and the patient is robust, 
two granules may be given every half hour until 
the bowels are thoroughly moved. 

When vomiting has occurred, or catharsis 
has been produced, two granules each of colchi- 
cine and benzoate of lithium, or benzoate of so- 
dium, should be given every two or three hours. 
If, however, the patient is delicate, it is best not 
to give the remedy so frequently as to produce 
diarrhoea. In such a case, two granules of col- 



76 COLCHICINE. 

chicine and two of lithium benzoate should be 
given every two or three hours and, if the bowels 
then move too freely, the quantity of colchicine 
should be reduced. Chronic rheumatism has 
frequently been cured by colchicine, which 
should be given in combination with bryonin if 
stiffness of the joints is a prominent feature. 
Give one or two granules of each every two or 
three hours but if diarrhoea supervenes the dose 
should be diminished. 

In chronic gout, in rheumatic gout and in 
those affections which occur because of a gouty 
or rheumatic diathesis, as gouty and rheumatic 
headache, gouty and rheumatic neuralgia, and in 
other complaints of a similar nature, colchicine 
is an excellent remedy*. In the treatment of 
these conditions, the best results follow after 
catharsis has been produced, which may 
be accomplished by giving two granules of 
colchicine every half hour or every hour. This 
active treatment should be followed by two 
granules of colchicine and two of benzoate of 
lithium given every three or four hours, and con- 
tinued for several weeks until all symptoms of 
the disease have disappeared. 

Two very obstinate cases of sciatica, one of 
several months' the other of two weeks' duration, 



*We have seen the most charming results from the use of 
colchicine in the pleurisy of those of the rheumatic diath- 
esis, used in combination with aconitine. In the light of 
present knowledge bryonin should also be added. — Pub. 



COLCHICINE. 77 

yielded to colchicine after many remedies had 
failed. Two granules were given every two 
hours until free purgation occurred. Then one 
granule was given every three hours. Improve- 
ment was manifest on the second and third days 
and the recoveries were complete. In neuralgia 
of rheumatic origin an equal number of arsen- 
iate of quinine gr. 1-6 should be given in con- 
junction with colchicine. 



-^yO^S 



CHAPTER XIII. 

CONVALLAMARIN (GLU.). 

Standard granule — Gr. 1-6, grra. .01. 

Dose — One every two or three hours as needed. 

Convallaria majalis, or lily of the valley, 
contains two glucosides, convallarin a cathartic, 
and convallamarin a heart tonic. In order to 
produce decided results in the treatment of dis- 
eases of the heart, it is necessary to give con- 
vallamarin in doses of not less than 1-6 of a 
grain every two or three hours and the amount 
may be gradually increased to one grain. When 
the muscular action of the heart is weak or 
when palpitation is prominent, with an irregu- 
lar, feeble and rapid pulse, whether these symp- 
toms are produced by an organic disease or 
only by functional derangement, convallamarin 
is a proper remedy. 

In dropsical conditions of cardiac origin, in 
cardiac dyspnoea and in venous stasis from 
disease of the mitral valves, this remedy is of 
special value. When convallamarin is admin- 
istered in these conditions, the heart is strength- 
ened, it beats with more regularity, the blood- 
pressure is increased, the pulse becomes fuller 
and stronger and the urinary secretion, in drop- 



CONVALLAMARIN. 



79 



sical cases, is greatly augmented. Convalla- 
marin resembles digitalin in its action and is used 
in all cases where the latter is indicated. The 
difference between these two remedies is, that 
convallamarin increases the appetite, while dig- 
italin diminishes it. Convallamarin is a com- 
paratively new remedy and it may be a long 
time before we can gain the confidence in it that 
we have in the older, well known and generally 
reliable remedy digitalin. 



-QyO^ 



CHAPTER XIV. 

COPPER ARSENITE. 

Standard granule — Gr. 1-250, grm. .00025. 
Adult dose — One to two granules, as indicated. 

Copper arsenite is chiefly used in the treat- 
ment of diseases of the gastro-intestinal tract, 
which have resulted from partaking of unwhole- 
some or of indigestible food. There are large 
numbers of such cases occurring, especially in 
summer, among infants as well as adults. Cop- 
per arsenite may therefore be prescribed in 
cases of vomiting, diarrhoea and colic, in cholera 
morbus or in cholera-infantum and in those 
cases in which pain follows the ingestion of 
starchy food. 

Whenever food, instead of being digested, un- 
dergoes fermentation, it produces colicky pains, 
vomiting and diarrhoea*. In the medicinal 
treatment of these cases, the object is to check 
fermentation and putrefaction, and to neutral- 
ize those , products of decomposition already 
formed and, according to Aulde, to re-establish 



*See article on sulpho-carbolate of zinc for the dia- 
tetic treatment of these cases. 



COPPER ARSENITE. 81 

the functional activity of the cells. One of the 
best remedies with which to accomplish this is 
copper arsenite. It usually checks vomiting, 
pain, and diarrhoea within a few hours. 

The action of this salt of copper is similar 
to the action of sulpho-carbolate of zinc, except 
in its lack of astringency. The taste of zinc 
sulpho-carbolate is unpleasant; when it is given 
in doses of one or two grains it frequently pro- 
duces nausea. Copper arsenite has, therefore, 
great advantages over zinc in the minuteness 
and in the tastelessness of the dose. The dose 
for an adult is one or two granules, each contain- 
ing gr. 1-250, grm. .00025. The remedy is best 
given in solution. Twenty-four granules may 
be dissolved in twenty-four teaspoonfuls of water 
and one teaspoonful should be given every 
fifteen minutes, every half hour, or every hour, 
according to the severity of the attack. 

For infants under one year, four to eight 
granules, gr. 1-250 each, should be dis- 
solved in twenty-four teaspoonfuls of water, 
and one teaspoonful should be given every 
fifteen minutes, every half hour or every 
hour. As improvement manifests itself, the 
same dose may then be given every hour, every 
two hours or every three hours. For children 
from one to five years of age, eight to twelve 
granules, gr. 1-250, should be dissolved in twenty- 
four teaspoonfuls of water and administered ac- 
cording to the direction given above. 



82 COPPER ARSENITE. 

Dr. Aulde, who lately reintroduced this valua- 
ble remedy, recommends smaller doses than 
those given by the writer. The object is not to 
give the copper in such doses as will produce 
irritation and, as no harm to the patient has ever 
occurred in his experience, the writer judges that 
his doses are not too large. 

It should be remembered that the great object 
of treatment, by means of this remedy, is to pre- 
vent further decomposition of the gastrointesti- 
nal contents and to stimulate the secretions of 
the gastro-intestinal glands. When this 

is accomplished, the medicine is grad- 
ually withdrawn. We are made aware that the 
remedy is accomplishing its object, when the 
vomiting, the pain and the diarrhoea are gradu- 
ally subsiding. Herein lies the secret of success 
with dosimetric medication. When symptoms 
are severe, remedies are given frequently, in small 
doses, and are continued until some improvement 
is manifested. The medicine is then gradually 
withdrawn. This method of administration re- 
duces to a minimum any risk of overdosing or of 
poisoning the patient. 

When pain follows immediately after the in- 
gestion of food, which indicates stomach indiges- 
tion, or several hours after, which indicates in- 
testinal indigestion, arsenite of copper, in doses 
of two granules, taken before meals, frequently 
brings relief The dose for children suffering 
from stomach or intestinal colic is the same as 



COPPER ARSENITE. 83 

that recommended in the treatment of diarrhoea. 
Dr. Aulde speaks highly of the administration 
of gr. 1-100 of copper arsenite in the treatment 
of sea-sickness. The dose should be taken be- 
fore meals. 

Various combinations may be made with cop- 
per arsenite. If fever is prominent, it may be 
given with aconitine; if pain is severe, with 
codeine or hyoscyamine; if there are mucous dis- 
charges, or if the stools are green, with emetine; 
and it should not be forgotten that this is a 
remedy of exceeding value, being at the same 
time economical and pleasant. 



^s-O'QS' 



CHAPTER XV. 

DIGITALIN (GLU.)- 

Standard granule — Digitalin ordigitingr. 1-67. 
Dose — One or two or more every two to four hours. 

Digitalis purpurea, or foxglove, contains, ac- 
cording to Schmiedeburg, digitonin, digitalin, 
digitalein, digitoxin and digitin*. Regarding the 
composition of digitalis, chemists are still at 
variance. Some assert that all of the active 
principles which have been separated repre- 
sent simple bodies and others declare, just as 
earnestly, that some of them represent com- 
pound bodies. 

It has not yet been determined by clinical 
investigation which of these substances is thera- 
peutically the most important. In dosimetry 
we use two kinds of granules; one contains 
1-67 of a grain of amorphous or "German dig- 
italin," composed of digitalein, digitoxin and dig- 



*Of these principles digitonin is to be avoided as it is an 
irritant. Digitalin and digitoxin are the stronger heart 
tonics, while digitalein is a weaker heart tonic but more 
strongly diuretic, therefore the combination of the three 
in the "digitalin" of The Abbott Alkaloidal Co. is most de- 
sirable. This preparation has but to be used to be ap- 
preciated. — Pub. 



DIGITALIN. 85 

italin, and the other contains 1-67 of a grain of 
"crystallized aigitaline, " or digitin. 

So long as a feeble and irregular pulse 
can be made strong and regular by doses 
of a derivative of digitalis, it is of little conse- 
quence whether it is named digitaline or digi- 
talin. The important thing is that the physician 
should always be able to obtain the same deriv- 
ative of uniform strength. 

In cases which seem to be particularly suited 
for its application, digitalis frequently fails to 
produce any result, hence it should not cause great 
wonder if one of its active principles 
fails to cure a patient. Usually some marked 
results are manifested if at all within one week 
after the treatment has been begun, especially 
in dropsical cases. If no improvement is ob- 
served within that time, some other preparation 
or some other derivative of digitalis should be 
tried. If these in turn fail, recourse may be 
had to convallamarin, cactin or sparteine and 
each can be given a trial. 

Sometimes one of these " heart tonics" pro- 
duces a very decided improvement and even a 
cure when all of the others have failed. Why 
this particular one should succeed, or what its 
special indication was, is not at present known. 
Digitalis, or its active principles, is the most 
important of all remedies for treating the dis- 
eases of the heart, and has justly been accorded 
the first place among the medicines of this class. 



86 DIGITALIN. 

A number of newer remedies, lauded by cer- 
tain enthusiasts, have been pushed forward as of 
superior value, but digitalis still remains the 
best, the most reliable and valuable remedy- 
known for the treatment of heart diseases. It 
is best to change heart tonics, after they have 
been given two or three weeks, and substitute 
one of the above named remedies for one week, 
returning then to the one first given. 

All remedies seem to loose their effect after 
they have been taken for a certain length of 
time unless the dose is increased, and it is bet- 
ter to substitute some drug acting in a similar 
way than to use larger doses*. 

Digitalin inhibits or slows the heart's 
action. By this slowing of the heart's activity, 
and by the reduction of the number of 
pulsations, a longer interval of rest is secured, 
during which the cavities of the heart are more 
completely filled, the circulation within its walls 
is improved . and the tonicity or contractility 
of its muscular fibres and of the blood-vessels 
is increased. 

The heart-muscles, therefore, contract with 
more force and vigor than before. The same 
rule which applies to all muscles applies also to 
heart muscles. If a muscle is made to con- 



*By doing this the nerve cells which have been hard 
worked under the stimulus of the first drug, and have lost 
their nervous tone, rest up and will again respond to the 
action of the first remedy. — Pub. 



DIGITALIN. 87 

tract more vigorously the muscle grows. So the 
heart grows under the influence of digitalin, not 
only in strength but in size and in weight. 

Through its action upon the vaso-motor centers, 
digitalin produces contraction of the muscular 
fibres of the arterioles and thus diminishes the 
lumen of the vessels; a greater resistance is 
thereby offered to the onward flow of blood. 
The heart, in its effort to overcome this resist- 
ance to the blood-stream, produced by the con- 
traction of the arterioles, beats with more vigor 
and the blood-pressure is raised within the blood- 
vessels. This rise in the blood-pressure is 
shown when digitalin is administered to patients 
suffering from dropsy. The pressure within 
the malphigian bodies is augmented and large 
quantities of urine are passed. The writer has 
seen the amount of urine increased from 
four ounces in twenty-four hours to eighty-four 
ounces. The increase in the amount of urine 
may be manifested before the number of pulsa- 
tions is reduced. Sometimes the number of 
pulsations is only slightly reduced, or not at 
all, yet general improvement is manifested, pro- 
duced by an increase of intra-vascular pressure. 
When from any cause organic or functional 
the number of pulsations is increased, while the 
pulse is feeble, easily compressed and irregular, 
when the impulse-beat is imperceptible and the 
valvular sounds are indistinct, when the im- 
>ression is conveyed to the mind of the physi- 



88 DIGITALIN. 

cian that the heart has lost its strength, and as 
a result the circulation is sluggish, when the 
kidneys are inactive through want of blood- 
pressure and dropsicial effusion is present in 
the cellular tissues, the best and the most reli- 
able remedy to correct these conditions is digitalin. 

When digitalin is administered to overcome 
the conditions stated above, the number of pul- 
sations may be reduced from one hundred and 
twenty or more to the normal, or below the nor- 
mal. The pulse is no longer weak and irregular 
but strong and regular. The valvular sounds are 
clear and distinct. The impression conveyed 
to the mind of the examiner is not that the heart 
is pulsating feebly but that it is vigorous in its 
action. The blood-pressure is greatly increased 
and the kidneys become wonderfully active 
which reduces the dropsical effusion. 

Unfortunately, digitalin cannot restore all 
feeble hearts to their former strength and vigor. 
There are many cases that resist all forms of 
treatment, gradually grow worse and end fatally. 
One reason of this failure is, that the nervous 
system does not respond to the action of digital- 
in. Some other remedy is needed which can 
better awaken the depressed nervous energy that 
is produced by a poor circulation, and this rem- 
edy is strychnine. It is of itself a heart tonic 
and better results are obtained when digitalin 
and strychnine are given in combination than 
when the former is given alone. 



DIGITALIN. 89 

In the treatment of diseases of the heart, one 
or two granules of digitalin may be given every 
two hours to adults, with two or three granules 
of arseniate of strychnine. In the treatment of 
children, the same rule which guides in the ad- 
ministration of aconitine is applicable to digi- 
talin. One granule for each year of the patient's 
age, together with one additional granule, should 
be dissolved in twenty-four teaspoonfuls of water. 
A teaspoonful of the solution should then be 
given as needed every one or two hours. 

When digitalin fails to improve the condition 
of the patient, excellent results may sometimes 
be obtained by combining digitalin with conval- 
lamarin, sparteine or cactin, even after these 
remedies have been singly tried and have also 
failed. Since digitalin is very slow in its action, 
when a prompt effect is desired, in treating a 
case of heart disease, caffeine or sparteine 
should be given hypodermically. In so-called 
cases of "heart-failure" glonoin, strychnine or 
atropine are also excellent remedies and pro- 
duce their effects rapidly; but in shock, when 
the pulse and respiration are below the normal, 
the remedy of the greatest value is atropine. 

In the treatment of dropsical cases, scillitine 
and caffeine, given in combination with digitalin, 
form one of the most potent of diuretics. We 
should remember, in using this combination, 
that caffeine not only stimulates the heart but 
also the epithelium of the uriniferous tubules 



go DIGITALIN. 

and these effects of caffeine, together with the 
diuretic effect of scillitine and the increase of 
blood-pressure produced by digitalin augment 
the quantity of urine and thus diminish the drop- 
sical effusion. 

Digitalin should only be given in those cases 
in which the heart beats rapidly and the pulse 
is feeble; its use is indicated even in the extrem- 
est degree of cardiac weakness. But, when the 
heart beats vigorously, with a strong impulse- 
beat, or when the pulse is slow, or when it is 
full and bounding, the administration of digitalin 
is contra-indicated. Digitalin is also contra-in- 
dicated after compensatory hypertrophy has set 
in. The heart's action, under the influence of 
this remedy, sometimes becomes so powerful 
that the pain and jarring produced by the im- 
pulse-beat is distressing and it becomes neces- 
sary to administer aconitine. The heart has 
grown too strong and must now be made weaker 
by means of aconitine. To continue the admin- 
istration of digitalin under these circumstances 
would, in all probability, prove fatal 

The physician should never neglect to instruct 
the patient, who is taking any of the preparations 
of digitalis, to withdraw the medicine as soon as 
he feels that the heart is beginning to beat 
strongly against the chest wall, or as soon as the 
pulse falls to the normal. This is the period 
which needs careful watching to prevent the so- 
called " cumulative action. " In palpitation ac- 



DIGITALIN. 91 

companied by feeble and rapid pulse, when in- 
digestion is also present, the mistake is fre- 
quenty made of believing that palpitation is pro- 
duced by derangement of the stomach. While 
this may sometimes be true, especially with pa- 
tients who partake excessively of coffee or tea, 
it should not be forgotten that a feeble and slug- 
gish circulation is often the cause of dyspepsia, 
which can only be cured by improving the con- 
dition of the heart. 

In typhoid fever, in phthisis and in other dis- 
eases of long duration, where the heart naturally 
becomes degenerated and weak because of con- 
tinued fever, two granules of digitalin and two 
of strychnine should be given three times a day. 
This treatment should be begun at once, in the 
early stages of the disease, and continued through- 
out its course. When physicians and nurses are 
overworked and have lost much sleep, there is 
frequently produced, upon the slightest effort, 
palpitation accompanied by vertigo and dyspnoea; 
in cases of this kind, two granules of digitalin 
and two of strychnine should be administered 
every three or four hours until the heart becomes 
stronger. 

Besides controlling abnormal action of the 
heart, digitalin possesses the power of contract- 
ing involuntary muscle-fibres. It can be used, 
therefore, to contract, the blood vessels and 
uterus, and is of special value in the treatment 
of congestion and of internal and uterine hem- 



92 DIGITALIN. 

orrhages. The writer fails to see, however, of 
what value digitalis can be in the treatment of 
post-partum hemorrhage, as recommended by 
so many authorities. In these cases something 
must be done quickly, must be done within half 
an hour, and digitalis cannot produce any effect 
within so short a time. If post-partum hemor- 
rhage could be anticipated and if digitalis could be 
administered in such small doses as not to pro- 
duce violent uterine contractions for one day be- 
fore labor began, or even if it were given during 
labor, some benefit might accrue, but this method 
is not advised. 

In the treatment of post-partum hemorrhage 
ergotin is far superior to digitalin, because it acts 
more quickly and it also can be given hypoder- 
mically. It is difficult to comprehend, therefore, 
why a remedy so slow in its action as digitalis or 
digitalin should be recommended and used in the 
treatment of post-partum hemorrhage, a condi- 
tion which may be so rapidly fatal. 

The best method for treating post-partum hem- 
orrhage is the preventive one, which consists in 
giving three or four granules of strychnine three 
times a day during the last months of gestation; 
this will insure a better and more active muscu- 
lar contraction by toning up the voluntary and 
involuntary muscular systems. The preventive 
method is still further carried out by giving er- 
gotin in large doses immediately after the ex- 
pulsion of the placenta. In the treatment of hem- 



DIGITALIN. 93 

orrhages which occur as the result of passive con- 
gestion, frequently accompanying disease of the 
mitral valves and dilation of the right ventricle, 
when the lungs are engorged and the sputum is 
frothy and bloody and dyspnoea is marked, or 
when metrorrhagia is produced by passive 
congestion, digitalin is a very useful 
remedy. 

If digitalin is used in the treatment of inter- 
nal hemorrhage arising from any cause, it should 
always be combined with ergotin. One granule 
of digitalin and six of ergotin should be given 
every half hour. If prompt action is desired, 
these granules should be dissolved and given hy- 
podermically. Whichever method is followed 
the dose should be repeated every half hour un- 
til the bleeding has ceased, or until the pulse 
is reduced to the normal. If there is much de- 
pression two granules of strychnine should be 
added to each dose. After the bleeding has 
ceased the medicine may be given every three 
or four hours. 

Because of the contractile power which digi- 
talin manifests over the arterioles, it has proved 
to be a very satisfactory remedy when used in 
the treatment of the cerebral congestion of de- 
lirium tremens and of the delirium of acute and 
chronic mania. Large doses are required and if the 
heart beats rapidly three or four granules may 
be given every two hours, watching, of course, 
its effect upon that organ. 



94 DIGITALIN. 

Spermatorrhoea accompanied by a weak pulse 
and other evidences of a poor circulation, when 
the erections are feeble and the ejaculations are 
premature, a condition produced by venous con- 
gestion, is best treated by giving one granule 
of digitalin and three of ergotin every two hours. 
Digitalis possesses undoubted properties as a feb- 
rifuge, and is given with excellent results in the 
treatment of scarlet fever, pneumonia and most 
acute inflammations. 

It should be administered throughout the en- 
tire course of scarlet fever, as first suggested by 
Daniel Lewis of New York, and in case it has 
not been given, if the urinary secretions become 
scanty and the pulse feeble or rapid, digitalin 
and caffeine are now especially indicated. 

Digitalin is one of three important constitu- 
ents used in the preparation of one of the most 
important granules in "dosimetry," a granule 
which is given in all asthenic cases when fever is 
present. The other two remedies, which are com- 
bined with digitalin to form one granule, called 
"Dosimetric Trinity" are aconitine and 
strychnine. 

The objection to the use of digitalis, besides 
the slowness of its action, is that it interferes 
with digestion and destroys the appetite. This 
frequently can be prevented, however, if the prep- 
aration used is given in combination with 
nux vomica. This objection does not exist, ap- 
parently, against the use of its active principle. At 



DIGITALIN, 95 

least the writer has never observed any trouble of 
this kind, probably because strychnine or quassin 
has usually been given by him in combination 
with digitalin. 

The great bugbear which has always haunted 
the physician when prescribing digitalis is its so 
called "cumulative action." This may b*e de- 
veloped during the administration of any poison- 
ous medicine. Opium pills have produced 
more deaths from " cumulation " than has digi- 
talis. If medicines are soluble in the gastric 
fluid or if they are administered in solution, and 
time is allowed for their absorption before other 
doses are given, and if their administration is 
stopped when the symptoms abate for which 
they were given, "cumulative action" cannot 
occur. 

Medicines do not circulate in the blood for 
days in an inactive or dormant state and then 
suddenly evolve their entire medicinal or poison- 
ous properties within a few seconds. Hard 
pills may remain undissolved in the stomach 
for days, where secretions have been scanty and 
absorption has been slight. When secretion 
and absorption are restored, all of the pills may 

*This is one of the strongest arguments in favor of the 
use of the active principles from which cumulative action 
never comes. The sick stomach is relieved of chemistry, 
that in its weakened condition it is often unable to perform, 
because the drug is ready for absorption when taken. 
Instead of being dangerous the active principles are the 
very quintessence of safety.— Pub. 



96 DIGITALIN. 

be quickly dissolved and rapidly absorbed into 
the blood and thus death may be produced. 

The following important lessons should there- 
fore be drawn from these facts Never give pills 
or granules when the mucus membrane of the 
mouth is dry, or is covered with sordes, but 
give the medicine in solution. Never adminis- 
ter medicines through the mouth to comatose 
patients but always give them hypodermically. 



^^o^^ 



CHAPTER XVI. 

EMETINE (ALK). 

Standard granule — Gr. 1-67, grm. .001. 

Dose — Expectorant, two to four every ^ to one or two 
hours. Emetic, five to ten granules in hot solution every 
ten minutes until effect. 

"Emetine is an alkaloid obtained from the root 
of ipecacuanha and is prepared in granules con- 
taining 1-67 of a grain. Emetine was discovered 
in 181 7 by Pelletier and Magendie. The yield is 
a little more than one percent." — Nat. Dispensa- 
tory. In the treatment of acute catarrhal dis- 
eases of the respiratory tract, especially in 
children, ipecacuanha has proved to be a remedy 
of the greatest value. 

In the treatment of bronchitis, a very common 
disease of childhood, emetine is one of our most 
reliable remedies. The prominence given to 
emetine need not surprise us, when we know 
that it represents the entire medicinal properties 
of ipecacuanha. It can be prescribed, therefore, 
in all cases in which ipecac is usually employed. 
When emetine is given to patients in small doses 



g8 EMETINE. 

(gr. 1-67) it increases the secretions of the 
mucous membranes of the gastro-intestinal and 
of the respiratory tracts. It should be used, 
preferably, in the beginning of inflammatory dis- 
eases of the mucous membranes of the air pas- 
sages, as in coryza, pharyngitis, laryngitis, 
trachitis and bronchitis. At this period the 
mucous membranes are dry, the secretions are 
scanty and the cough is harassing and painful. 
If, under these circumstances, emetine is given in 
small doses frequently repeated, marked changes 
are quickly produced. The dryness is soon re- 
lieved, the secretions become free, while the 
cough grows less severe, soft and painless. 
If fever is present, aconitine should be combiner 
with the emetine, and aconitine may be given 
in half the usual dose even when fever is not 
present. The patient improves much more 
rapidly and no doubt, in many cases, the advent 
of fever is prevented. 

In the treatment of the diseases mentioned 
above, the following prescription is suitable for 
a child of one year. Twelve granules of 
emetine and one or two granules of amorphous 
aconitine (^gr. 1-134) should be dissolved in 
twenty-four teaspoonfuls of water, and one tea- 
spoonful of this mixture may be given every half 
hour or even- hour. As the patient improves 
the dose should be given every one or every two 
hours. Two additional granules should be added 
to the above prescription for each year of the 



EMETINE. 99 

patient's age until the fifth year is reached. 
Children from five to ten years of age may take 
one granule, and adults may take two or three 
granules every half hour or every hour. 

Emetine is a remedy as free from dangerous 
effects as is ipecec. When given in large me- 
dicinal doses, nothing more severe than emesis 
and purgation can occur, and one or the other 
of these effects is not only desired but produced 
as a part of the treatment in certain diseases. 

In cases of spasmodic and of membranous 
croup, in the suffocative stage of capillary bron- 
chitis, in pertussis, in asthma or in any dry, 
spasmodic cough, and in rigidity of the os uteri, 
if emetine is administered in large doses every 
fifteen minutes until nausea or vomiting is pro- 
duced, relief usually follows. To produce 
nausea in children under ten years of age, from 
one to three granules may be given while, to 
older children and adults, five to ten granules 
may be given dissolved in hot water. If emetine 
is given in the above large doses, it may produce 
catharsis, provided emesis can be prevented by 
the patient's remaining perfectly quiet and suck- 
ing small pieces of ice, or by a mustard plaster 
applied to the epigastrium, just before the med- 
icine is taken, or by codeine combined with 
emetine. 

Because of the cathartic action of emetine, 
it is successfully used in the treatment of acute 
dysentery. The same dose which causes vomit- 



loo EMETINE. 

ing, if given at intervals of two hours and 
guarded by codeine, will produce dark-green 
bilious-looking stools, after which there is usually 
a subsidence of the tenesmus and pain. The 
efficacy of emetine in the treatment of dysentery 
does not depend upon any specific action beyond 
its cathartic action, for castor oil, epsom salt and 
seidlitz salt are remedies which cure dysentery 
just as quickly as ipecac or emetine. All of the 
remedies act in a similar manner; they relieve 
the usually filled and distended colon and re- 
duce the inflammation by draining the congested 
capillaries. 

Emetine is successfully used in the treatment 
of internal hemorrhages, as hemoptysis, men- 
orrhagia and post-partum hemorrhage. To be 
effective, however, it must be given in emetic 
doses every fifteen minutes, until nausea or 
vomiting is produced. Recurrent pulmonary 
hemorrhage is frequently prevented by giving 
ten to fifteen granules of emetine as soon as the 
first premonitory symptom is manifest. Debility 
does not contra-indicate its use. The act of 
emesis does not aggravate the bleeding, as one 
would naturally suppose, neither is the patient 
injured by the depression which usually accom- 
panies nausea and vomiting. 

Its prompt effect as a hemostatic cannot be 
explained by any specific action. The general 
relaxation produced by large doses of emetine 
permits the blood to flow into remote parts of 



EMETINE. 101 

the body. By this diversion of the blood-stream 
from the seat of hemorrhage, and by the lower- 
ing of the blood-pressure, the bleeding necessarily 
ceases. ■ If emetine produces relaxation of the 
voluntary and of the involuntary muscles, as 
every one must admit, it cannot check bleeding 
by producing contraction of the arterioles, as is 
taught by many authorities. 

In the summer-diarrhoea of teething children, 
when the stools are green, slimy and bloody, 
emetine should be freely administered in com- 
bination with zinc sulpho-carbolate. In gastric 
catarrh of adults, where large quantities of 
mucus are vomited, two or three granules of 
emetine and the same amount of zinc sulpho- 
carbolate given before meals frequently restores 
digestion by curing the catarrh. Two granules 
each of emetine and of arseniate of soda is an 
excellent combination to be used in those cases 
of dyspepsia in which heaviness or pain is most 
marked when the stomach is empty. 

While large closes of emetine produce vomit- 
ing, small doses, half of a granule, will fre- 
quently relieve the vomiting of pregnancy. 
Finally, emetine is a slow but safe emetic to 
administer when improper food or too much 
food has been taken, or whenever it is desired to 
produce vomiting in the young or in the aged. 



CHAPTER XVII. 
ERGOTIN (AQ. EXT.). 

Standard granule — Gr. i-6, grm. .01. Also in tablets of 
from one to five grains. 

Dose — According to the nature of the case. 
Ergotin is a purified aqueous extract of ergot, 
and is prepared in granules which contain one- 
sixth of a grain. Ergotin may also be obtained 
in tablets containing one, two, or five grains, 
which sometimes are more convenient than 
granules for dispensing, and for administration. 

Various substances have been obtained from 
ergot, and as each one was discovered, there 
was always a hope that this might prove to be 
the right thing. But, as yet, not one of these 
substances has unanimously received the 
distinctive title of the active principle of ergot. 
At present, ergotin is the purest, the most reli- 
able and stable preparation, and may be used in 
all cases in which ergot is usually prescribed. 

Nearly all authorities recommend the hypoder- 
mic injection of ergotin in cases in which ergot 
is indicated, that is, when prompt effect is desired 
in dangerous hemorrhages or, where, instead, 
rapid, more decided and thorough effects are 
wanted, as in uterine fibroids, subinvolution of 



ERGOTIN. 103 

the uterus, varicocele and varicose veins. It is 
surprising that ergotin is not given the prefer- 
ence at all times and not merely when superior 
results are required. 

Ergotin administered during labor produces 
most decided tetanic contraction of the uterus. 
This contraction is continuous and so powerful 
as dangerously to delay parturition, to rupture the 
uterus or perineum, and to cause the death of 
the child by compression of the placental circu- 
lation, which cuts off its blood supply or produces 
paralysis of the fcetal heart. Ergotin should 
never be used during labor, but only after the 
placenta has been expelled. If administered 
before expulsion of the placenta, uterine con- 
tractions may be so great as to make it very 
difficult to remove the retained mass. Ergotin 
is our most valuable preventive of post-partum 
hemorrhage and should be given immediately 
after the completion of the third stage of labor, 
whether bleeding is profuse or scanty. Its use 
insures a more rapid, permanent uterine con- 
traction. 

If post-partum hemorrhage is apprehended, 
or if the bleeding is severe, it is best to inject 
five grains of ergotin subcutaneously every half 
hour until firm contraction is produced. 

Digitalin is of no value in this class of cases, 
because it is too slow in producing its effects. 
Strychnine is of greater value than digitalin, if it 
is given hypodermically in doses of one-thirtieth 



io 4 ERGOTIN. 

of a grain. If strychnine is taken during the 
last month of gestation, in doses of four granules 
three times a day, post-partum hemorrhage is 
not likely to occur*. Ergotin produces contrac- 
tion of the uterus and of the arteries; not directly, 
by stimulating the muscular fibres and through 
the vaso-motor nerves as was formely believed, 
but by decreasing the heart's action, by reducing 
the blood-pressure, by filling the veins and 
depleting the arteries. According to Schles- 
inger, Wermick and others, this condition of the 
arteries, produced as above, results in their pas- 
sive contraction and that b)'this means the blood 
in the uterus is diminished, and the anemia thus 
produced, irritates this muscular organ and 
causes it to contract. This convulsive or spas- 
modic muscular action is similar to that which 
occurs in animals that have been bled to death. 
It is fortunate for patients that medicines may 
be administered and cures effected without its 
being absolutely necessary that the physician 
should first know the exact modus operandi 
of the remedy. We know that ergotin is our 
best internal hemostatic, and that it can be used 
in the treatment of all internal hemorrhages, 
including cerebral, that it can be used in the 
treatment of active congestions, and that it will, 
therefore, relieve congestive headache, delirium 



*This is a point that should not be lost sight of. With 
proper diet and the use of strychnine and hyoscyamine we 
can do much "j& render labor safe and easy. — Pub. 



ERGOTIN. 105 

of sthenic cases, inflammation and congestion 
of the brain and cord and of their covering. In 
fact, ergotin should be of value in all active 
congestions and inflammations of all organs and 
structures. 

In the treatment of such cases, from four to 
six granules, or as much as two or three grains, 
should be given every hour or every two' hours. 
Uterine fibroids are frequently cured by produc- 
ing arterial anemia with ergotin. The uterus and 
blood vessels contract. This cuts off the blood 
supply of the growth, which must necessarily 
atrophy. Sometimes the uterine contractions 
even expel the fibroid mass. The treatment 
in these cases is necessarily long. One or two 
grains of ergotin and three granules of strychnine 
should be taken four times a day for several 
months. 

Subinvolution, menorrhagia, when accom- 
panied by a large, soft, spongy uterus, can be 
cured by means of ergotin and strychnine. One 
of the unpleasant effects of ergotin is that it pro- 
duces contraction of the sphincter vesici, and 
thus causes retention of urine. In cases of 
incontinence, therefore, where there is lack of 
muscular tone, ergotin often effects a cure. 
This can be more rapidly produced by combining 
strychnine with ergotin. Diabetis insipidus has 
frequently been cured by a course of ergot. It 
was first employed for this purpose by Da Costa. 
Diabetes mellitus is probably produced by con- 



106 ERGOTIN. 

gestion of the glycogenic center in the floor of 
the fourth ventricle, which produces congestion 
of the liver. These conditions clearly indicate 
the use of ergotin, and a reasonable hope of 
relief may be entertained from its administration 
in large doses. 

In spermatorrhoea, where flaccidity of the 
genitals is marked and the erections are feeble, 
ergotin and strychnine are the remedies which 
will restore the lost strength or tone to these 
organs. According to the latest theory regard- 
ing the action of ergot, there seems to exist an 
antagonism between the action of this remedy 
and that of digitalis, remedies that are frequently 
used in combination for the cure of internal 
hemorrhages. Ergot lowers blood-pressure, while 
digitalis increases it, ergot produces a passive 
contraction of the arteries by depleting them and 
filling the veins with blood*; digitalis produces 
an active contraction of the arteries by stimulat- 
ing the vaso-motor centers, and instead of pro- 
ducing venous congestion improves venous 
circulation. 

Whatever the theory, ergot and its derivatives 
are our best internal hemostatics, being both 
rapid and effective in their action. Digitalis 
and its derivatives, in properly selected 
cases, are synergists and, when strychnine 
is added to ergotin and digitalin, a potent 

*For this reason aconitine might well be combined with 
ergotin to increase its effect. — Pub 



ERGOTIN. 107 

combination is formed which may be used 
successfully to produce contraction of ar- 
teries, and of involuntary muscle-fibres, and in 
this way hemorrhages are not only checked but 
the desired condition is permanently main- 
tained. 



<^0<^v 



CHAPTER XVIII. 

GELSEMININE (ALK). 

Standard granule — Gr. 1-250, grm. .00025. 
Dose — One to four granules every half hour, or every 
one or two hours according to the effect desired. 

GELSEMIN (CON.). 

Standard granule — Gr. 1-134, grm. .0005. 
Dose — One to two granules every half hour or every one 
or two hours. 

Gelseminine, also erroneously written gel- 
seminin and gelsemine, is the active principle 
of gelsemium sempervirens, or yellow jasmine. 
The yield of the alkaloid, according to Worm- 
ley, is 0.2 per cent. 

Gelsemin is a concentration, which contains the 
above alkaloid, as its effects are similar to those 
produced by the administration of gelseminine. 

Whether gelseminine the alkaloid, or gelsemin 
the concentration is used, it is advisable to ad- 
here to the use of the one, after becoming 
thoroughly familiar with its action, and not 
change to the other. Either granule is reliable 
and will usually proauce the effect desired in 
cases in which this remedy is indicated. 

Throughout the south and west gelseminine 
is chiefly employed because of its efficacy 



GELSEMININE. 109 

as a febrifuge. In many other parts of 
our country this remedy is administered 
particularly in all kinds of neuralgia. If one 
or two granules of gelseminine are taken every 
half hour, by a person in good health, there is 
soon perceived a feeling of languor and an in- 
disposition to move. The arms and legs feel 
heavy, the upper eye-lids droop, in spite of all 
efforts to raise them, and the pupils dilate. 
When given in large doses it "induces paralysis 
of both sensation and motion, sometimes of one 
first, and sometimes of the other, lowers the 
force and rate of the pulse and respiration, re- 
duces temperature, dilates the pupils, projects 
the eyeballs but does not suspend the heart's 
action until the respirations have ceased. " — Nat. 
Dispensatory. 

In the treatment of many cases in which gel- 
seminine is indicated, it is necessary to produce 
some slight physiological effect of the medicine 
before improvement is manifested. 

If small doses of gelseminine are given until 
improvement is manifested or until the first phy- 
siological effects of the medicine are experienced, 
and it is then given at greater intervals, poison- 
ing cannot occur. 

Gelsemium is regarded as a dangerous remedy, 
especially when used to reduce fever. This 
reputation is well earned because of the large 
doses of the cruder preparations that are often 
given. If these preparations are used, they 



no GELSEMININE. 

should be given in small doses, frequently 
repeated. As a result of fatalities from the use 
of tinctures and fluid extracts of poisonous med- 
icines the following false deduction is made. 
If crude preparations are dangerous, the active 
principles of these medicines must be more 
dangerous.* 

Many of the active principles of plants are 
looked upon by some physicians as a class of 
medicines which should be left upon the shelves 
of the chemist as specimens to exhibit the result 
of his indefatigable research. 

With the various crude preparations of gelsem- 
ium as with all other crude forms of medicine, 
the danger lies in not knowing just how much 
active principle is contained in a given dose. 
There may be little or there may be much accord- 
ing to the conditions under which the plant grew, 
the circumstances attending its getting and the 
manipulations through which it has passed. Who 
but the chemist will undertake to answer how 
much? There is but one wa}' to reduce this 
danger to a minimum, and that is to use known 
qualities of active principles by prescribing the 
unchangeable, and accurately measured alka- 
loidal (dosimetric) granules. 

It may possibly be a hindrance to the use 
of the active principles according to Burggraeve's 



*I desire to emphasize the author's statement of this most 
manifest error which has stood stupidly in the way of ther- 
apeutic advancement so many years. — Pub. 



GELSEMININE. in 

method, that the physician is compelled to know, 
at least, the primary physiological effects of the 
medicines which he uses. When it is necessary 
to push a remedy, he should also impart this 
knowledge to his patient. When a patient is 
given gelseminine he should be told that just as 
soon as a languid feeling overcomes him and his 
eyelids grow heavy and droop/ the medicine 
should be taken at greater intervals. When 
gelseminine is given in full doses, physiological 
effects are usually manifested within half an hour 
and continue for at least two hours. When 
marked effects are felt, it should not be given 
of tener than every two hours. 

When a patient is fully under the influence of 
gelseminine he experiences muscular weakness 
and loss of sensibility to pain. The remedy is 
indicated, therefore, in all spasmodic contrac- 
tions of the voluntary and of the involuntary 
muscles and in painful nervous diseases, neural- 
gia, neurites, etc. J. N. Freeman considers 
gelsemium a most valuable remedy; he has 
given it with success in intermittent fevers of 
children with involvement of the nervous system, 
in fevers of dentition, dysentery, infantile rheu- 
matism, convulsions, tetanus of the new-born 
and meningitis. In chorea he considers it the 
best of all remedies. In convulsive or spas- 
modic coughs, as in whooping cough and in 
asthma, gelsemium is highly recommended by 
Bartholow. 



ii2 GELSEMININE. 

When good results are thus obtained from the 
use of crude preparations, better results will 
follow the use of the active principles and there 
need be no hesitancy in using them. For the 
above cases one, two or three granules of gelsem- 
inine may be given to adults every half hour 
until some improvement is manifested, or until 
a feeling of langour is perceived. The dose 
should then be given every two hours. In treat- 
ing children observe the aconitine rule* — dis- 
solve in twenty-four teaspoonfuls of water one 
granule for each year of the patient's age together 
with one additional granule. A teaspoonful of 
this solution should be given every hour in acute 
cases and every two hours in chronic cases. 

Besides the effect which gelseminine has in 
controlling exalted muscular action, it is also of 
value, as before stated, in relieving exalted sen- 
sations, or pain. In neuralgia of the facial nerve, 
of the sciatic, in ovarian neuralgia and in dys- 
menorrhea, gelseminine is a remedy of great 
value. The pains accompanying uterine cancer 
are often relieved by the use of this alkaloid. 
Pruritus vulvae, especially when of nervous origin 
and pruritus accompanying eczema and urticaria 
are benefitted and cured by means of gelseminine. 
In treating these diseases, two or three granules 



*I desire to emphasize the fact that the author was the 
first to formulate this rule for the treatment of children 
and that it is of the greatest importance to have it always 
clearly in mind. — Pub. 



GELSEMININE. n3 

given every hour will usually be sufficient. If 
no improvement follows they may be given 
every half hour until the eyelids become heavy, 
after which the two hour interval should be 
observed. 

Gelseminine has been used extensively in the 
treatment of remittent fever, pleurisy, pneu- 
monia and meningitis. It should be used only 
in sthenic cases, however, because of its depressing 
power. If strychnine is administered in conjunc- 
tion with gelseminine, much of its depressant 
action is lost. Gelseminine is also used to relieve 
the nagging pain in the beginning of labor, and 
to check after pains. 

In " dosimetry " we have in aconitine a febri- 
fuge which is vastly superior to gelseminine and 
free from all danger. Still, if it is desirable to 
give gelseminine in febrile cases, it may be given 
every half hour until improvement is noted, and 
then every hour or every two hours. 

If the action of the lungs and heart is de- 
pressed, or, in order to prevent this depression, 
strychnine and caffeine are the remedies 
indicated. If the febrifuge qualities of gelsem- 
inine are further developed and appear advan- 
tageous, a compound granule might well be pre- 
pared in which gelseminine, digitalin and strych- 
nine could be combined. All depressing action 
would then be avoided. 



CHAPTER XIX. 

GLONOIN. 

Standard granule — Gr. 1-250, grm. .00025. 

Dose — One granule dissolved on the tongue every fif- 
teen minutes until effect and then every half to one or two 
hours as needed to maintain the same. 

Glonoin, trinitrin and angio-neurosine are all 
synonyms for nitro-glycerin. In dosimetric 
medicine it is prepared in granules which con- 
tain 1-250 of a grain, grm. .00025. It can also 
be obtained in a one per cent solution. When 
one or two granules of glonoin are placed upon 
the tongue and allowed to dissolve, absorption 
takes place rapidly. Within five minutes, usually, 
the heart beats more forcibly and quickly, the 
head feels full and there is a throbbing in the 
temples; the face grows hot and flushed, while 
drowsiness and languor often follow. 

When larger doses have been administered, or 
when small doses have been given to susceptible 
patients, severe, throbbing headache, vertigo, 
nausea, weak pulse and even unconsciousness 
sometimes occur. 

Nitro-glycerin is an extremely useful and 
potent remedy and it is not so dangerous to use 
as might be inferred from its name. Except in 
cases of emergency, it is safest to begin with 



GLONOIN. 115 

doses of one granule, or with one-half drop of 
the one per cent solution. The dose may be 
gradually increased and repeated every fifteen to 
thirty minutes until some marked physiological 
effect is produced. When the proper dose for 
the individual is ascertained, it should be repeated, 
to keep up the impression, every half to one 
hour. 

The effects of glonoin are not lasting and 
usually pass away within an hour. Good resul's 
do not follow the use of this remedy, unless 
flushing of the face, fullness of the head, or in- 
crease of the heart's action is produced. In 
cases of emergency, where death seems impend- 
ing, four granules dissolved in hot water, or in 
hot whiskey, or two drops of a one per cent solu- 
tion, should be injected hypodermically, and 
this may be repeated every fifteen to thirty min- 
utes until some improvement is observed. 

The most alarming symptoms produced by 
taking glonoin are quickly recovered from, with- 
out bad or lasting effect. It is doubtful if death 
has ever been produced by the internal adminis- 
tration of medicinal doses of this remedy. 

Physiologically, glonoin acts only upon the 
vaso-motor centers and produces dilatation of 
the arterioles in all parts of the body, an effect 
which is especially manifested by marked red- 
ness of the face. The indications for its use, 
therefore, are not difficult to comprehend and 
the best results are obtained in diseases in which 



n6 GLONOIN, 

paleness of the face, coldness and clammi- 
ness of the general cutaneous surface are present. 

During a paroxysm of renal, hepatic, uterine, 
stomachic or intestinal colic, the face is pale and 
the skin is cold and moist. The arterioles of the 
integument are contracted and those in the organ 
or structure involved may also be contracted. 

If this is the case, capillary anemia results 
and it is well known that sudden anemia pro- 
duces pain and spasmodic contractions of mus- 
cular tissue. On the other hand, the arterioles 
in the organ and structure involved may be dilated, 
and congestion of the part ensue, while the arte- 
rioles in all other parts of the body are con- 
tracted. Nitro-glycerin, given under these cir- 
cumstances, by its action upon the vaso-motor 
centers, overcomes the contraction of the arte- 
rioles, wherever it exists, and the previously 
anemic capillaries are distended with blood. 

It cannot always be apparent whether the con- 
gestive, or the anemic condition is the cause or 
the result of the pain, but this fact remains, that 
if the remote capillaries are filled with blood, and 
the circulation in the structure involved is re- 
stored to the normal, the pain is relieved, which 
shows, at least, that some disturbance of the 
blood- supply was the cause of the pain. 

A very common and severe pain, which is 
most frequently produced by congestion, is dys- 
menorrhea. Throbbing, aching and pricking 
sensations, in the womb, are complained of, pre- 



GLONOIN. 117 

vious to or during the first hours of men- 
struation. 

Degeneration and exfoliation of the uterine 
mucous membrane proceeds slowly. The dis- 
tended or congested capillaries cannot disgorge 
themselves when covered by this firmly organ- 
ized membrane as they can later, when cov- 
ered by one that is softening, breaking down, and 
desquamating. The object of treatment in these 
cases is to relieve the uterine and ovarian con- 
gestion by diverting the blood to other parts of 
the body, and this can be accomplished by admin- 
istering one granule of glonoin every half hour 
until fullness of the head or flushing of the face 
is produced, after which one granule may be 
given every hour or every two hours. Nitro- 
glycerin may be employed for this purpose every 
month, without resulting in any harm to the 
patient. 

That most dreaded disease, angina pectoris, 
which in its true form is accompanied by pallor, 
is, fortunately, very often relieved by dissolving 
two granules of glonoin in the mouth, or by giv- 
ing the same dose subcutaneously ever fifteen 
minutes. 

In the treatment of all diseases of the heart, 
where feebleness of its action is particularly 
marked, as in fatty degeneration or in dilatation, 
the circulation in remote parts is improved, the 
heart is relieved of undue pressure, and is stim- 
ulated to increased activity by the administration 



n8 GLONOIN. 

of nitroglycerin. In all cases of syncope, and 
in so-called heart-failure, which occur, frequently 
in pneumonia, typhoid fever, hemorrhage and in 
diarrhoea, glonoin, hypodermically given, is, 
undoubtedly, the most efficient remedy. It 
often restores life when all indications seemingly 
point to dissolution. 

For these cases, one or two drops of a one 
per cent solution, or three or four granules dis- 
solved in hot water, may be injected every fifteen 
minutes, until there is some evidence of recovery. 

No physician should be without glonoin 
in his emergency case. There is no remedy 
which can be used in the treatment of collapse 
that is so quick and sure in its action. Parox- 
ysms of asthma, especially when the expectora- 
tion is scanty, migraine, facial neuralgia, hiccough, 
sea-sickness, reflex, vomiting, toothache, vertigo 
and tinnitus aurium are reported by various 
authorities as having been cured by the use of 
nitro-glycerin. 

In the cases last mentioned, if the face is 
flushed relief does not usually follow the use of 
this remedy, but when the face is pale good re- 
sults may be expected. 

The therapeutic value of glonoin depends upon 
its power to relax the small arteries and flush 
the cutaneous capillaries. If they are already 
distended with blood, the remedy is of no value. 
One granule should be administered every half 
hour until headache or throbbing in the temple 



GLONOIN. 119 

is produced; the dose may then be given every 
two hours. A number of physicians have report- 
ed cases of asphyxia, resulting from inhalation 
of illuminating gas, in which recovery speedily 
followed hypodermic injections of 1-50 of a 
grain of nitro-glycerin. 

This remedy should be used, therefore, in all 
cases of asphyxia, in asphyxia of the new born, in 
cases of drowning, hanging, also in narcosis pro- 
duced 037 ether or chloroform. The congestive 
stage of malarial fever or of any inflammatory 
disease may be aborted by means of this remedy. 
Nitro-glycerin is undoubtedly the most rapid 
and reliable divertant of the blood-pressure 
known, and should therefore be more extensively 
used in the treatment of acute and chronic in- 
flammations, for, by distributing the blood to re- 
mote parts and equalizing the blood -pressure, 
the diseased structure is relieved of its conges- 
tion and cure must frequently follow. 

This remedy should always be used in the 
treatment of acute and chronic Bright's disease. 
It is of especial value when the pulse is hard 
and firm and the arteries are small and narrow. 
Glonoin overcomes the capillary constriction, 
giving a better circulation through the periph- 
eral vessels, and restores the circulation within 
the kidneys to the normal state. Wonderful 
results have been produced by its use in this 
disease. It should be given in two granule 
doses every three hours. Its effect should be 



120 GL0X0IN 

carefully watched and, if physiological mani- 
festations are not produced, the dose should be 
carefully increased. 

Bartholow advocates the use of nitro-glycerin 
in the treatment of anemia. It improves the 
circulation in remote structures and increases 
the energy of the heart. There is no doubt that 
in many cases anemia results from inadequate 
circulation of the blood because of feeble action 
of the heart. Many diseases, concomitant 
with feeble cardiac movement, have their origin 
in poor circulation through some one of the or- 
gans. These diseases cannot be treated through 
that organ but only by improving the condition 
of the heart. So it is with anemia, better results 
may be obtained in many cases by giving heart 
tonics or heart stimulants than by giving prep- 
arations of iron. 



^^O^v> 



CHAPTER XX. 

HYOSCYAMINE AND HYOSCINE (ALK.). 

Standard granule — Amorphous hyoscyamine, gr. 1-250, 
grm. .00025; crystalline hyoscyamine, gr. i-iooo, grm. 
.0000625; hyoscine hydrobromate, gr. i-iooo, grm. 
.0000625. 

Dose — Of either, one or two granules every one-quarter 
to one-half or one hour till effect and then as needed to 
maintain the same. 

The seeds, leaves and flowering tops of hyos- 
cyamus niger contain the alkaloids hyoscyamine 
and hyoscine. "The dried seeds yield from 
0.08, to o. 16 per cent and the leaves 0.042 to 
0.224 per cent °f hyoscyamine." — National Dis- 
pensatory. There are two forms of hyoscy- 
amine, the amorphous and the crystalline. The 
former is prepared in granules containing 1-250 
of a grain, grm. .00025, and the latter in gran- 
ules containing i-iooo of a grain, grm. .0000625. 

The writer uses only the amorphous from 
which he obtains full physiological effects. Hyo- 
scine, as an alkaloid, is seldom used, the prefer- 
ence being given to its salt, the hydrobromate, 



*The amorphous hyoscyamine is to be preferred for 
ordinary use as it contains not only hyoscyamine but 
hyoscine also. — Pub. 



122 HYOSCYAMINE AND HYOSCINE. 

which is prepared in granules containing i-iooo 
of a grain, grm. .0000625. 

When hyoscyamine is taken in doses of one 
or two granules every half hour, there is soon 
perceived dryness of the mouth and throat, 
dilatation of the pupils, increase of the number 
of pulsations and respirations, and redness of 
the face. If the dose should be continued after 
these effects are noted, delirium, illusions, and 
hallucinations would occur. Hyoscyamine acts 
upon the sympathetic nervous system and, when 
dosimetrically prescribed ( that is in small doses), 
it stimulates the vaso-motor centers and in- 
creases the arterial tension. Larger doses pro- 
duce opposite effects*. Hyoscine and hyoscy- 
amine are similar in their action, and may be used 
interchangeably. Hyoscine is more powerful and 
is more likely to produce delirium. It should 
always be used in smaller doses than hyoscy- 
amine. 

Atropine and hyoscyamine are, physiologically 
and therapeutically, similar in their action and 
may be used in the treatment of the same class of 
diseases. Hyoscyamine has one decided advan- 
tage over atropine, in that it possesses greater 
hypnotic properties. It is, therefore, used in 
cases of acute and chronic mania, in delirium 
tremens and in fevers, when accompanied by 



*Notice here again the dual action of the drugs of this 
class and do not wonder at the conflicting reports given. — 
Pub 



HYOSCYAMINE AND HYOSCINE. 123 

great mental excitement. As the mental excita- 
tion of the insane is one of its chief indications, 
this remedy has been extensively used by those 
specialists who have charge of this unfortunate 
class of patients. Prideaux declares "that it is 
the most reliable narcotic we possess." 

Coleman and Taylor say that, " hyoscyamine 
never fails to act as a prompt and powerful seda- 
tive in cases of mental excitement, and that no 
bad afier-effects follow. " 

Hyoscyamine, in doses of 1-120 to 1-60 of a 
grain, was found by Lemoine " to be a safe, more 
certain and more efficient hypnotic, in acute 
mania, than hyoscine in similar cases." 
Robert regards "hyoscine as a feeble narcotic 
for healthy men. In mental diseases, on the 
other hand, it acts so powerfully that no remedy 
can rival it." The great weight of authority 
seems to be in favor of the use of hyoscyamine, 
in preference to that of hyoscine. 

Both of these alkaloids may be given hypoder- 
mically and they then produce their effects very 
rapidly. Sleep usually follows within ten or fif- 
teen minutes when hypnotic doses have been 
given. In order to produce sleep, it is better 
to give one large dose than several smaller doses; 
1-125 of a grain, should never be exceeded«as an 
initial dose, because of the peculiar susceptibility 
shown by some patients to the influence of this 
medicine. This may be repeated within half an 
hour and may be gradually increased day by day 



124 HYOSCYAMINE AND HYOSCINE. 

until 1-60 of a grain has been given at a single 
dose. Some physicians have given as much as 
1- 10 of a grain with no bad results. 

Large doses should not be given unless it has 
been found that smaller doses are without effect. 
The object should be, always, to obtain results 
with as small a quantity of medicine as possible, 
and not to see what large amounts patients can 
take without being poisoned. Hyoscyamine is 
comparatively a harmless remedy when given in 
medicinal doses and, when given according to 
the rules laid down by Professor Burggraeve, no 
harm can possibly result from its use. Unpleas- 
ant symptoms, which have resulted from large 
doses, such as dizziness, muscular weakness and 
delirium, fortunately, have rapidly and completely 
subsided. 

In all spasmodic affections of the involuntary 
muscles, as asthma, laryngismus stridulus, enter- 
algia, uterine, vesical, renal and biliary colic, 
and in recent hernia, one granule of hyoscya- 
mine dissolved in hot water, and given every 
fifteen minutes, will usually relieve pain and re- 
lieve muscular spasm, after several doses, have 
been taken. The administration! of this remedy 
may be persisted in until the pupils are dilated 
or until the mouth becomes dry. If the patient 
has derived no benefit by this time, hyoscyamine 
is powerless to afford relief in this case. 

Burggraeve particularly emphasizes the use- 
fulness of hyoscyamine as an aid in the reduc- 



HYOSCYAMINE AND HYOSCINE. 125 

tion of hernia, after taxis has failed. Dr. W. C. 
Abbott reported a case in May, 1894, of a large 
scrotal hernia which could not be reduced by 
taxis, but was quickly restored after the patient 
was under the influence of hyoscyamine. In all 
spasmodic coughs, hyoscyamine usually proves 
to be an excellent remedy. It may be combined 
with codeine, lobeline or emetine. In cases of 
irritable bladder, in which there is bearing or 
squeezing pain after micturition, this remedy acts 
as a sedative to the urinary tract. In the tenes- 
mus of dysentery, hyoscyamine often relieves 
the pain and straining of this disease. Two or 
three granules given at bedtime frequently pre- 
vent the night-sweats which accompany phthisis 
and other exhausting disorders. 

As an adjunct to cathartics, hyoscyamine is of 
value, since it prevents the griping which this 
class of remedies usually produces. In affections 
of the nervous system, in which the voluntary 
muscles are abnormally influenced to excessive 
action, as in paralysis agitans, palsy, senile 
trembling, hydrophobia, tetanus, and even in 
mercurial tremor, hyoscyamine, according to 
Charcot and Oulmont, either works a cure or 
affords relief. 

Hyoscyamine is a very useful remedy in treating 
the disease of children, and may be used success- 
fully to allay spasms, to soothe fretting and 
cross infants who are suffering from teething and, 
especially, to quiet those colicky children who 



126 HYOSCYAMINE AND HYOSCINE. 

cry almost constantly. Children bear hyoscy- 
amine better than they do most alkaloids and re- 
quire larger proportional doses. 

The rule for the administration of aconitine 
will not do in the case of hyoscyamine, for 
children require just twice as many granules of 
hyoscyamine, gr. 1-250, as of aconitine, gr. 1-134. 
The following table applies to the administration 
of this drug. 

Infants from 1 to 3 months require 1 granule 
dissolved in 24 teaspoonfuls of water. 

Infants from 3 to 6 months require 2 granules 
dissolved in 24 teaspoonfuls of water. 

Infants from 6 to 9 months require 3 granules 
dissolved in 24 teaspoonfuls of water. 

Infants from 9 to 1 2 months require 4 granules 
dissolved in 24 teaspoonfuls of water. 

A child of 2 years requires 6 granules dissolved 
in 24 teaspoonfuls of water. 

A child of 4 years requires 10 granules dis- 
solved in 24 teaspoonfuls of water. 

For children twelve years old and upwards, and 
for adults, one granule of hyoscyamine is the 
dose. In prescribing for older patients, the 
doses may be given as frequently as every fifteen 
minutes, but for young children every half hour 
or every hour will be often enough. 



CHAPTER XXI. 

LOBELINE (ALK). 

Standard granule — Gr. 1-134, grm. .0005. 

Dose — Two to three every one-half to one hour. 

Lobeline is the alkaloid of lobelia inflata or 
Indian tobacco, and is prepared in granules 
containing 1-134 of a grain, grm. .0005. When 
lobeline is given in large doses it acts as a power- 
ful emetic and, so great is the accompanying de- 
pression, that it should never be administered for 
this purpose to weak or delicate individuals. In 
all dry, spasmodic coughs and in asthma, two or 
three granules, administered every half-hour, or 
every hour, soon overcome the spasm and pro- 
duce free expectoration. 

In severe attacks of spasmodic asthma, the 
remedy should be persisted in until relief or 
nausea is produced. The general muscular re- 
laxation which follows large doses, or frequently 
repeated small ones, is often utilized to relieve 
strangulated hernia. Lobelin, a concentration 
prepared in granules containing 1-12 of a grain, 
is a very excellent preparation, equal to the 
alkaloid in relieving asthma, and should be given 
in doses of one granule every half hour. 



CHAPTER XXII. 

MERCURY BI-CHLORIDE AND CALOMEL. 

Standard granules — Calomel.gr. 1-6, grm. .01, and gr. 
1-67. grm. .001. Bi-chloride, gr. 1-134 grm. .0005. 
Dose — According to the result desired. See text. 

Of the many preparations of mercury that are 
medicinally used, the therapeutical properities 
of only two will be here mentioned. All 
the preparations are of more or less value 
as therapeutical agents, but the representative 
mercurials are calomel and the bi-chloride. 
The chief objection that may be urged against 
the administration of mercurials is the danger of 
producing salivation, and this danger should 
always be remembered when prescribing any of 
these remedies. Some individuals possess a pe- 
culiar susceptibility to the action of mercurials, 
and manifest symptoms of poisoning after taking 
a small amount of the medicine; a single dose 
of calomel has produced marked pt3^alism. 

As salivation does not usually manifest itself 
until several days after the administration of the 
mercurial, there is, of course, no opportunity to 
withdraw the treatment in those cases where it 
is necessary to maintain it only for a few hours. 



MERCURY BI-CHLORIDE AND CALOMEL. 129 

Great caution is, therefore, necessary when 
administrating calomel to very delicate 
patients. 

Mercury is eliminated from the blood by the 
kidneys, the pancreas, the intestinal glands and 
the salivary glands. Very little harm usually 
results when mercury is eliminated by the first 
three structures but, when the salivary glands 
are very active in its removal, stomatitis may be 
produced by the presence of mercury in the 
saliva. If, therefore, the function of the salivary 
gland can be checked for a time, by the use of 
atropine, as suggested by Bartholow, salivation 
may be prevented. Hence, while calomel is 
probably the best intestinal antiseptic, its use 
must be restricted, and its action must be care- 
fully watched because of its liability to produce 
salivation. 

In derangements of the gastro-intestmal canal, 
especially in cholera-infantum and in summer 
diarrhoea of children, caused by the presence of 
decomposing food, which by its irritation pro- 
duces vomiting, pain and diarrhoea, the remedy 
that will most effectually evacuate the intestines 
and render them aseptic is calomel. In vomit- 
ing, especially where the stomach is very irrit- 
able, relief is frequently obtained by giving 
small doses of calomel. Two or three granules, 
gr. 1-67, should be administered to an adult every 
half hour, while one granule (which should be 
crushed) may be given to children one year old. 



i 3 o MERCURY BI-CHLORIDE AND CALOMEL. 

When vomiting is checked the medicine should 
be discontinued. 

In the treatment of diarrhoea in adults, four 
granules, gr. 1-67, should be given every half 
hour and, for children from one to three years 
old, one granule, until the character of the stool 
is changed. The calomel should then be with- 
drawn and sulpho-carbolate of zinc administered 
until the patient is well. 

In the treatment of typhoid fever this remedy 
is almost a specific. In whatever period of the 
disease the patient is first seen, whether at the 
beginning of the attack, or at any subsequent 
time, whether diarrhoea or constipation exists, 
the first medicine to be prescribed is calomel. 
In every case in which this remedy has been 
used by the writer, the fever declined and the 
patient's condition improved. If fever returned 
the same treatment was again given. 

In administering calomel in the treatment of 
typhoid fever it should always be combined with 
bi-carbonate of soda. A tablet containing 1-10 
of a grain of calomel and two grains of bi-carbon- 
ate of soda is a very convenient form. If tablets 
are not at hand, a teaspoonful of the soda should 
be dissolved in a glassfull of water and a swal- 
low of this solution should be taken with each 
dose of the granules. The dose for an adult is 
six granules, gr. 1-67, or one of the tablets, and 
should be given every half hour, until the stools 
are changed from their characteristic appearance 



MERCURY BI-CHLORIDE AND CALOMEL. 131 

of pea soup, to a darker color. With this 
change in the color of the stool, the fever dimin- 
ishes, and rarely returns to the height it had 
reached at the time the calomel treatment 
was begun. Whether we adhere to the theory 
that calomel checks, or to the opposing theory 
that it increases the secretion of bile, is not of 
so much importance as a knowledge of the fact 
that when calomel is administered in typhoid 
fever the condition of the patient is wonderfully 
improved. 

In the stools produced by calomel, bile is 
certainly present, no matter what the theory 
may be, and two of its functions, the increase of 
peristalsis and the prevention of decomposition 
are performed during its passage through the 
intestines. Similar properties, with an addi- 
tional one, that of increasing the intestinal secre- 
tions, belong to calomel. A union of bile and 
calomel, therefore, forms a powerful antiseptic 
cathartic, which not only empties the intestinal 
tract of decomposing fecal matter, but also 
checks fermentation, and prevents further ab- 
sorption of septic material. 

The calomel treatment, in cases of typhoid 
fever, should be followed by the administration 
of zinc sulpho-carbolate. The administration 
of soda is supposed to render the patient less 
liable to salivation. The treatment of typhoid 
fever just outlined has been used by the writer 
very extensively, for several years, and in no 



132 MERCURY BI-CHLORIDE AND CALOMEL. 

case has salivation been observed. The only- 
precaution used to prevent this' danger, was the 
combination of soda with calomel, and the with- 
drawal of the remedy as soon as darker stools 
were produced. 

The only explanation which can be offered 
why salivation is not produced in cases of ty- 
phoid fever is, that the salivary secretion is dim- 
inished because of the accompanying fever, while 
the intestinal secretion is increased, as shown by 
the almost invariable presence of diarrhoea. The 
more active intestinal glands take upon them- 
selves the elimination of what mercury is ab- 
sorbed, and thus relieve the salivary glands. 
When calomel is given to a patient who has di- 
arrhoea, the frequent evacuations do not allow the 
medicine to remain long within the intestines, 
only a limited amount, therefore, can be ab- 
sorbed, and in this way salivation is pre- 
vented. 

In the treatment of inflammatory croup and 
diphtheria, one granule containing 1-6 of a grain 
of calomel, should be administered every half 
hour, to a child from three to five years of age, 
until the stools become of a darker brown or 
green color. Good results rarely follow the ad- 
ministration of calomel, unless the stool shows 
evidence of an impression made upon the intes- 
tines. Whether it produces any effect upon the 
liver or not is still a matter of dispute, but a so- 
called "bilious stool," produced in these diseases 



MERCURY BI-CHLORIDE AND CALOMEL. 133 

is usually followed by a reduction of the in- 
flammation which produces the dyspnoea. 

Dropsical effusions are sometimes absorbed 
with astonishing rapidity through the diuretic 
action of calomel, but the remedy must be given 
in larger doses than those prepared in dosimet- 
ric granules. The method generally followed is 
to give three grains each of calomel and bicar- 
bonate of soda, three times a day for three days. 
Diarrhoea may be guarded against by codeine, 
while ptyalism may be prevented by atropine as 
suggested by Bartholow, and above referred to. 

On the third or fourth day from the beginning 
of the treatment, if calomel has been effective, 
the kidneys manifest a wonderful activity, which 
quickly reduces the dropsy by the daily passage 
of ten or twelve pints of urine. Sometimes cal- 
omel fails, especially where the kidneys have 
undergone marked pathological changes. 

MERCURY BI-CHLORIDE. 

Our most powerful- germicide is bi-chloride of 
mercury. It is the most important remedy in 
the treatment of that dreaded disease, syphilis. 
In the treatment of the secondary form of this 
disease it is a specific. Two or three granules 
may be given every three or four hours, until 
the gums become slightly tender, which can be 
discovered by the patient's biting upon his teeth. 
Patients should practice this biting frequently 
and, as soon as tenderness is observed, the 



134 MERCURY BI-CHLORIDE AND CALOMEL. 

granules should be taken only two or three times 
daily, or entirely withdrawn for a few days if 
salivation is produced. 

In order to cure syphilis, it may be necessary 
to continue the mercurial treatment for months, 
sometimes for a year. Salivation should be pre- 
vented, if possible, but it seems to be necessary 
that the gums should feel slightly the influence 
of the medicine before marked results can be 
produced. If salivation occurs, it is best treated 
by the internal administration of atro- 
pine and by a local wash made of chlorate of 
potash. 



^0^> 



CHAPTER XXIII. 

MORPHINE AND CODEINE (ALK.). 

Standard granules — See text. 
Dose — According to effect desired. 

Morphine and codeine are two of the many 
alkaloids of opium. Morphine is the principal 
alkaloid, and is used more extensively than all 
of the others combined. Of these two remedies, 
the more active is morphine. One fourth of a 
grain of morphine is therapeutically equivalent to 
one grain of codeine. 

The following preparations are found in the 
alkaloidal granule lists. Morphine hydrobrom., 
gr. 1-67; morphine muriate, gr. 1-12 and gr. 1-67; 
morphine sulphate, gr. 1-12 and gr. 1-67; and 
codeine sulphate, gr. 1-6 and gr. 1-67. 

The principal indication for the use of opiates 
is pain. If opium and its derivatives were used 
only to relieve pain, they would probably be 
more widely useful in their application than any 
other remedy. Fortunately, opiates, the best 
and most important of all remedies, are not only 
anodynes but have other important properties. 

They are chief among narcotics or hypnotics and 
produce quiet sleep where there is great excitement 



136 MORPHINE AND CODEINE. 

and restlessness. Their application is invaluable in 
the treatment of many nervous diseases. 

In the treatment of internal hemorrhages they 
allay all anxiety and quiet the excited heart. As 
antispasmodics they relieve asthma, paroxysms 
of coughing, angina pectoris, tenesmus or mus- 
cular spasms and colic. They act upon the 
secretions and are, therefore, important remedies 
in checking diarrhoea, excessive mucous discharges 
and the increased flow of urine in diabetes. 

From these indications for their use it would 
appear that the application of opiates is almost 
unlimited. Unfortunately, a means of great 
good is only too often a means of great evil, and 
this double function is performed coincidently. 
The step from good to evil is thus unobserved. 
The possibility, no the probability, of this step 
should never be lost sight of. 

While opiates have relieved much pam and 
saved the lives of thousands, they have been the 
cause of untold sorrow and anguish, and of the 
wreck and destruction of innumerable lives. The 
physician has, only too often, thoughtlessly and 
innocently initiated the victim into the terribly 
deplorable life of the opium taker. 

Opium, administered during physical or men- 
tal suffering, produces a feeling of ease, relief 
and mental comfort; the brain is stimulated and 
the thoughts flow freely; suffering and anguish are 
things of the past, whose return seems impos- 
sible. It is doubly deplorable when the phy- 



MORPHINE AND CODEINE. 137 

sician himself learns of the seductive charms of 
this useful but dangerous remedy. He knows 
of its power in affording relief and, without one 
thought as to its consequences, takes dose after 
dose, apparently never realizing that he has 
become a victim to the habit. 

This is the history of hundreds of physicians, 
whose usefulness in the medical world is totally 
destroyed. When the pleasant effects of opiates 
have passed away, and its narcotic effect is no 
longer felt, there frequently follows a ■ train of 
disagreeable symptoms, as nausea, vomiting, 
dryness of the tongue, vertigo, headache and 
general depression. To prevent these after- 
effects, atropine is usually combined with opiates. 

Codeine is very much milder in its action than 
morphine, and rarely produces subsequent disa- 
greeable symptoms, while its therapeutical prop- 
erties are similar to those of morphine. It is 
the only derivative from opium which should be 
used in the treatment of children and, in the 
treatment of adults it should be more frequently 
employed. It ought to be better understood, 
and more fully appreciated than it is; so 
far as is at present known, the taking of codeine 
does not lead to its habitual use. 

In nearly all cases where morphine is indi- 
cated, codeine may be used as a substitute. In 
the treatment of all painful diseases of the gas- 
trointestinal canal, as colic, peritonitis, dysen- 
tery, diarrhoea and cholera morbus, codeine is 



i 3 8 MORPHINE AND CODEINE. 

superior to other opiates. The anodyne effect 
of codeine can be increased by the addition of 
hyoscyamine. When the pain is severe, three 
granules of codeine, gr. 1-6, and one granule of 
hyoscyamine amorphous, gr. 1-250, should be 
given every half hour until there is relief; the 
dose may then be given, if required, every one or 
two hours. 

If diarrhoea is present, three granules of sul- 
pho-carbolate of zinc, gr. 1-6, and three granules 
of codeine, gr. 1-6, or a tablet containing codeine 
and zinc, aa gr. 1-2, may be given every half 
hour, until improvement is marked.* A dose 
should then be taken after each stool. 

This combination of codeine and zinc is prob- 
ably the best prescription for diarrhoea arising 
from any cause. In entero-colitis, accompanied 
by soreness or pain, with frequent, mucous and 
blood-stained discharges, codeine and emetine 
in combination frequently effect a cure. 

When pain follows the ingestion of food, two 
or three granules of codeine, gr. 1-6, taken one 
half hour before eating, afford marked relief. 



*Since the above was written a tablet has been devised, 
with the approval of Dr. Shaller, that more clearly meets 
the indications present in these cases. Each contains 
zinc sulpho-carbolate, gr. 1; codeine sulphate, gr. 1-4; 
hyoscyamine amorphous, gr. 1-250, with strychnine sul- 
phate, gr. 1-134. This is made by The Abbott Alkaloidal 
Company and is known as ' ' Zinc Sulpho-carbolate Com- 
pound." It is a most excellent combination and one having 
a wide range of usefulness. — Pub. 



MORPHINE AND CODEINE. 139 

Neuralgia of all kinds is quickly relieved by a 
hypodermic injection of 1-6 of a grain of mor- 
phine combined with 1-120 of a grain of atropine. 
In the treatment of distressing coughs, especially 
in the aged, few remedies can be compared with 
codeine in affording prompt relief. One. two or 
three granules., gr. 1-6, may be given every half 
hour. The dose may be increased if found 
necessary, or may be combined with one of the 
following expectorants, emetine, apomorphine, 
calcium sulphide, lobeline or scillitine. 

Morphine should never be prescribed in the 
treatment of dysmenorrhea or ovarian pains, 
because of the great danger of creating the mor- 
phine habit. A remedy free from this danger, 
as we have shown above, and at the same time 
equally efficacious, is codeine, which, when given 
in conjunction with hyoscyamine or with macro- 
tin, if the menstrual flow is scanty, forms an 
anodyne of great usefulness. In painful dis- 
eases of the bladder also, codeine and hyoscya- 
mine form a combination which gives excellent 
results. 

The slow solubility of codeine (except the 
phosphate) is one reason why it has not been 
more frequently employed for hypodermic med- 
ication. Preference is therefore given to mor- 
phine on this account, for hypodermic use, and 
also, no doubt, because morphine relieves neural- 
gia and pain generally, except pain in the abdom- 
inal organs, more effectively than does codeine. 



i 4 o MORPHINE AND CODEINE. 

The physician is always desirious to relieve 
pain. It is usually such an easy thing to do 
and, in his anxiety to give relief quickly, he ad- 
ministers larger doses and more frequently than 
is required. 

When prescribing opiates in chronic diseases, 
especially when the patient is of a nervous type, 
the danger of the opium habit, with all of its 
terrible consequences, should be ever promi- 
nently present in the mind of the physician. 
On account of different effects of morphine 
upon different individuals, 1-6 of a grain given 
hypodermically, should rarely be exceeded for 
the first dose. If relief is not manifest within 
twenty minutes, the dose may be repeated. 
When prompt relief from pain is desired, the 
hypodermic method should be employed, par- 
ticularly if persistent vomiting is present which 
interferes with the retention and absorption of the 
medicine. 

The usual dose of morphine, hypodermically, 
is one- sixth to one-fourth of a grain, and this 
may be repeated several times at intervals of fif- 
teen to thirty minutes. It should be remembered 
that one-half of a grain is the smallest dose of 
morphine known to have caused death in an 
adult. Morphine and atropine are physiological 
antagonists. The former contracts the pupil 
while the latter dilates it. In a case of poison- 
ing by either medicine, the other is used as an 
antidote, but only so far, however, as to over- 



MORPHINE AND CODEINE. 141 

come the condition of the pupil. In opium or 
morphine narcosis, only small doses of atropine, 
1-100 of a grain, should be given, and this not 
more than two or three times at intervals of half 
an hour. 

The object is not to overcome narcosis and 
to awaken the patient for, if this should 
be attempted by large and frequently repeated 
doses of atropine, only a deeper sleep would result. 
If the contracted pupil relaxes and the pulse 
and respiration are restored to a normal ratio, 
atropine has done all it can possibly do. In 
conjunction with atropine, codeine may be ad- 
ministered hypodermically, in doses of one-fourth 
to one-half grain, and the injection repeated two 
or three times at intervals of half an hour or an 
hour. 

Prescribing opiates for children is always 
hazardous. As a rule they bear the drug badly; 
they are more susceptible to its evil influences 
than they are to those of any other medicine. 
There is not the same certainty in calculating 
the proper dose of an opiate for children, which 
shall be entirely free from danger, as in calcu- 
lating doses of other poisonous drugs. Again, 
idiosyncracies exist to a greater extent than 
among adults. For these reasons, the mildest of 
the derivatives of opium, that which possesses the 
fewest objectionable features and is freest from 
danger, should always be used when prescribing 
for children. The alkaloid which possesses all 



142 MORPHINE AND CODEINE. 

of these qualities, and is equal to morphine in 
many respects, while superior to it in others, is 
codeine. 

Opium and morphine should never be pre- 
scribed for infants. Codeine is the remedy when 
an anodyne is indicated. The diseases, which 
probably require opiates more frequently than 
any other class are those of the gastro-intestinal 
canal, the pain is usually severe and the patient 
should have immediate relief. 

Gastro-intestinal pains are most frequently 
produced by the presence of indigestible food, 
which by fermenting evolves gases and produces 
irritating acids. Naturally, the best method for 
treating such conditions, instead of giving opiates 
to relieve pain, the result of which is to check 
peristalsis and to lock up decomposing material 
within the bowels, is to evacuate the canal. 

This can be accomplished by giving an emetic, 
as emetine or apomorphine, and a cathartic, as 
calomel or effervescent seidlitz salt. This 
should be followed by the administration of 
zinc sulpho-carbolate. 

If the pain persists, and inflammation is not 
present, spirits of camphor or monobromated 
camphor may be given in hot milk, or hyoscya- 
mine, which is an excellent anodyne, may be 
given in solution to children and in granules to 
adults. If colicky pains are of daily or almost 
of continuous occurrence with infants, there is 
usually something wrong with the diet; this 



MORPHINE AND CODEINE. 143 

should be corrected, and pepsin, diastase or 
papoid given with each meal. Opiates should 
not be used, as they only afford temporary re- 
lief, check secretions and produce constipation. 

When, however, it is absolutely necessary 
to give opiates, let it be, as indicated above, co- 
deine combined with hyoscyamine. After mak- 
ing several attempts to find a proper dose for a 
colicky baby of four weeks, who was crying all 
day and all night, the writer found that the fol- 
lowing prescription gave prompt relief. In a 
three-ounce vial of water, there were dissolved 
five granules of codeine, gr. 1-67, and two gran- 
ules of hyoscyamine amorphous, gr. 1-250, with 
some saccharine. A teaspoonful was given every 
half hour and after one or two doses, quiet 
usually reigned. 

While frequent administration of opiates in 
small doses may not always give such a prompt 
relief as a single large dose, the element of 
danger is eliminated, and only so much of the 
medicine is given as is necessary to relieve the 
pain. In this way, too, the bad after effects, 
which are produced when large doses are given, 
are avoided. It frequently requires several days 
for the nausea, vertigo and foul breath to 
disappear. 



CHAPTER XXIV. 

PILOCARPINE (ALK). 

Standard granule — Of the nitrate, gr. 1-67, grm. .001. 
Dose — Two to six granules every one or two hours. 

Jaborandi contains two alkaloids, pilocarpine 
and jaborine. While both these principles are 
obtained from the leaflets of jaborandi, they are, 
therapeutically, as antagonistic as it is possible 
for two medicines to be. 

When jaborandi is administered to a patient, 
it usually produces copious sweating and saliva- 
tion. In case it fails to produce these results, 
the preparation used must have contained an 
unusual amount of jaborine, which has an action 
similar to that of atropine and, therefore, antag- 
onizes pilocarpine. In order to reduce the num- 
ber of such failures to a minimum, the various 
preparations of jaborandi should be replaced by 
the alkaloid, pilocarpine. 

When pilocarpine is injected subcutaneously, 
there is usually produced, within five minutes, 
vertigo and flushing of the face, neck and breast, 
which is followed by paleness. Drops of sweat 
make their appearance, first around the seat of 
injection, then upon the forehead and, gradually, 



PILOCARPINE. 145 

over the entire body. Saliva flows in a constant 
stream from the mouth, tears run down the cheeks 
and the secretions of the entire respiratory and 
alimentary tracts, and particularly of the pancreas, 
are augmented; the pupils are contracted; the 
heart and lungs perform their function more 
rapidly; the pulsations sometimes increase from 
twenty to fifty beats; the blood-pressure is low- 
ered and the temperature falls from one-half to 
two degrees. The effects of pilocarpine last 
about four hours, and as much as two pints of 
saliva may be secreted and more than twice this 
amount of perspiration. 

Naturally, after a copious sweat and a loss of 
other secretions, with depression of the heart's 
action and fall of body-temperature, there must 
follow chilliness, fatigue, drowsiness, great weak- 
ness and depression. These facts should always 
be prominent in the mind of the physician, when 
administering pilocarpine to weak and delicate 
patients. 

If pilocarpine fails to act upon the skin and 
salivary glands, it may act with unusual vigor 
either upon the kidneys, the stomach, the intes- 
tines or the lungs. If this is the case, large quan- 
tities of urine may be excreted; thick ropy mu- 
cus may be vomited; profuse diarrhoea may be 
produced or frothy mucus may be continually 
expectorated. 

From the effect of pilocarpine upon the lungs, 
serious results may be anticipated, especially 



146 PILOCARPINE. 

when they have undergone marked pathological 
changes. Bronchial mucus is formed in such 
large quantities as greatly to embarrass the weak- 
ened lungs in their effort to expel it, sometimes 
they are unable to do so and death ensues. 
This remedy is contra-indicated, therefore, where 
the lungs are weak or diseased, also where the 
pulse is rapid and feeble, and the heart has lost 
its vigor and tone, and, finally, in gastrointesti- 
nal irritation and inflammation. 

By its action upon the glandular system, pilo- 
carpine proves itself to be a very active evacu- 
ant. Under favorable circumstances, it can 
eliminate from the body from two to six pints of 
fluid. It maybe used, therefore, in all cases of 
dropsy, as anasarca, hydro-thorax, hydropericar- 
dium, and ascites. When disease of the kidneys is 
the cause of the dropsical effusion and where the 
heart is strong, a reduction of the effused fluid is 
most rapidly produced by the administration of 
pilocarpine. 

To see a patient fully under the influence of 
pilocarpine, is to see an extremely uncomfort- 
able and wretched individual. The eyes are red 
and tears are streaming down the cheeks; a thin 
mucus is dripping constantly from the nose, 
saliva is running in a steady stream from the 
mouth; perspiration is oozing from every pore 
and the body is soaking wet, shivering and cold. 
In addition to these effects, there may be vertigo, 
vomiting, diarrhoea, polyuria and constant cough- 



PILOCARPINE. 147 

ing in order to clear the lungs of increased bron- 
chial secretion. 

For what purpose must a patient undergo 
this ordeal ? Simply, that several pints of fluid 
may be removed from the system. In uremic 
poisoning, especially in puerpera-l eclampsia, 
where life is in great danger, relief must be 
obtained as quickly as possible. In such cases 
pilocarpine administered hypodemically in doses 
of one-half grain, by reducing cedema of the 
brain and by removing urea from the blood, 
may be the means of saving life. When there 
are five hours, at least, during which the patient's 
life is in no danger, a hydrogogue cathartic, as 
jalapine or bryonin, given in combination with 
a large dose of seidlitz salt, or our good, old 
calomel and jalap, will do the same. 

The reduction of the dropsical effusion is just 
as certain and just as rapid as when pilocarpine 
is used; there is not much depression and very 
little, or no harm can result to the patient, and, 
certainly, he is much more comfortable during 
the action of a cathartic, than during that of 
pilocarpine. 

Precaution is necessary when prescribing this 
remedy for women during pregnancy, because of 
its tendency to induce labor-pains. In this one 
respect it has an action similar to that of ergot- 
ine, but is more powerful. When given during 
labor, it increases the strength and duration of 
uterine contractions. 



148 PILOCARPINE. 

Pilocarpine augments the secretions of the 
nasal, pharyngeal and laryngeal mucous mem- 
branes and, on this account, it is recommended 
by Guttman as a remedy to be used in treating 
diphtheria with the hope, that the membrane 
may be more easily detached. As is usual with 
favorite remedies, some physicians report that 
they save the lives of all of their diphtheritic 
patients, while others, equally capable, have lost 
every case. 

In diphtheria, when the lungs are involved 
and the pulse is rapid, feeble and easily obliter- 
ated, so depressing a medicine as pilocarpine 
must necessarily act with great detriment to the 
patient. In this feeble state the remedies indi- 
cated are caffeine and strychnine. When the 
membrane is in the fauces or in the larynx, and 
the patient is fairly strong, pilocarpine, given 
every hour in doses large enough to stimulate 
free secretion, frequently produces expulsion of 
the membrane. 

In order to produce free laryngeal and pharyn- 
geal secretion, it is not necessary to give large 
doses. For a child of one year, three granules, 
gr. 1-67, should be dissolved in twenty-four tea- 
spoonfuls of water and one teaspoonful given 
every half hour, or every hour. Three granules 
may be added to the prescription for each year 
of the patient's age. 

Children are not as susceptible to the action 
of pilocarpine as are adults. As this remedy 



PILOCARPINE. 149 

increases the glandular secretions, it may be 
used to advantage in cases of suppression of 
milk, or even where the secretion is scanty. 
Four granules given every three hours will fre- 
quently restore the flow of milk, or, in cases 
where the supply is insufficient, the quantity 
will be augmented. In these cases, in conjunc- 
tion with the administration of pilocarpine, the 
patient should be given the best nitrogenous 
diet possible, as meat, milk and eggs. 

Pilocarpine frequently produces irritation of 
the gastro-intestinal canal and causes vomiting 
and diarrhoea. When this occurs the medicine 
should be withdrawn. If this remedy is given 
early in the course of an attack of mumps, the 
disease may be aborted. It depletes the parotid 
glands by increasing the flow of saliva from 
them and thus reduces the inflammation. Pilo- 
carpine may be used as a substitute for eserine 
in diseases of the eye, since it, when locally 
applied, produces contraction of the pupil. 

The most marked antagonism exists between 
pilocarpine and atropine. Pilocarpine contracts 
the pupils, increases all of the glandular secre- 
tions, produces primary flushing of the face and 
secondary pallor. Atropine dilates the pupils, 
checks glandular secretions, produces primary 
pallor and secondary flushing of the face. Each 
of these alkaloids may be used as an antidote to 
overcome the evil effects of the other. Atropine 
should always be given in those cases where 



150 PILOCARPINE. 

pilocarpine has caused such an excessive secre- 
tion of bronchial mucus as dangerously to em- 
barrass the action of the lungs. Incidentally, 
it has been observed that bald-headed patients, 
who were undergoing a course of treatment with 
pilocarpine, have had their growth of hair re- 
stored. 

It has, therefore, been utilized, either by inter- 
nal administration or by external application to 
the scalp, to stimulate the growth of hair and to 
restore gray hair to its natural color. 

From the preceding it will be seen that pilo- 
carpine is an efficient diaphoretic, sialogogue, 
expectorant, galactogogue, mydriatic and hair- 
restorer. The diseases for which pilocarpine may 
be prescribed are uremic poisoning, hydrothorax 
and dropsies of all kinds not having their origin 
in the heart, mumps, diphtheria, and other in- 
flammations of the throat, larynx and bronchi. 



*^o*^ 



CHAPTER XXV. 

PODOPHYLLIN (RES.). 

Standard granule — Gr. 1-6, grm. .01. 

Dose — One or two, three times a day, or three to six at 
once. 

Podophyllin is a resin obtained from the rhiz- 
oma and roots of podophyllum peltatum, or May 
apple, and is prepared in granules containing 
1-6 of a grain. When three to six granules are 
taken, there is usually produced, within six 
hours, a copious, thin stool, preceeded very 
probably by griping and nausea. 

Many physicians use podophyllin exclusively, 
whenever a cathartic is required. It is a very 
useful remedy to overcome habitual constipation, 
torpidity and congestion of the liver, and catarrhal 
jaundice. Chronic constipation is frequently 
cured by the use of small doses. One or two 
granules should be given half an hour before 
meals. If griping is produced, one granule of 
hyoscyamine should be added to each dose. As 
soon as one stool is produced each day, the dose 
should be diminished, or one of the doses may 
be omitted. The granules should be withdrawn 
gradually, as improvement advances. In cases 



152 PODOPHYLLUM. 

of habitual constipation, it usually takes several 
weeks to effect a cure. When very prompt ac- 
tion is required, from three to six granules 
should be taken, with one granule of hyoscya- 
mine and, to produce rapid and free action, a 
tablespoonful of seidlitz salt should be given 
two hours later. 



^^0^> 



CHAPTER XXVI. 

QUASSIN (GLU.). 

Standard granule — Gr. 1-67, grm. .001. 
Dose — One to three before meals. 

Quassin is the bitter principle of quassia, and 
is prepared in granules as above. Quassin is, 
undoubtedly, the best bitter, stomachic tonic and 
promoter of the appetite that we possess. It 
acts by stimulating the gastric glands to in- 
creased activity and is thus, indirectly, a diges- 
tant. Quassin is an excellent remedy to be used 
in all cases of indigestion where nausea, eructa- 
tion or epigastric pain exists, as a result of fer- 
mentation, in consequence of a poor quality of 
gastric juice. 

In convalescence, few remedies are better suited 
to restore loss of appetite. In chronic dyspepsia, 
especially of drunkards, where large quantities 
of mucus are vomited, two or three granules each 
of quassin and emetine, given before meals, 
frequently effect a cure. 

Migraine, consequent upon a feeble digestion, 
often yields to a course of quassin. If an acid is 
indicated, two or three granules of phosphoric 
acid may be given in conjunction therewith. 



CHAPTER XXVII. 

QUININE (ALK). 

Standard granule — Gr. 1-67, grm. .001. For special 
sizes and dosage see text. 

Quinine is one of the alkaloids obtained in 
variable quantity, 2 1-2 to 9 per cent, from the 
bark of various species of cinchona. In dosimet- 
ric medicine, the following granules are used; 
quinine arseniate, gr. 1-6 and i-67;hydrobromate, 
gr. 1-6; hydro-ferrocyanate, gr. 1-6 and 1-67; 
picrate, gr. 1-6; salicylate, gr. 1-6; valerianate, 
gr. 1-6 

When quinine is dosimetrically used, or when 
it is prescribed in doses of one or two grains, 
it is a bitter tonic, antiperiodic, antiseptic and 
a cardiac and cerebral stimulant. When quinine 
is used in larger doses it is an antipyretic, oxy- 
toxic, and a cardiac and cerebral depressant. It 
is also a poison to protoplasm, in as much as it 
checks the ameboid movement of white blood 
corpuscles. 

Full medicinal doses of quinine — from five to 
twenty grains — produce hyperaemia of the brain, 
which can be observed by ocular demonstration 
in the retina and in the tympanic membranes. 



QUININE. 155 

Accompanying this congestion, there is tinnitus 
aurium, and a sensation of fullness in the head 
with some vertigo. Temporary blindness and 
deafness have been produced by large doses of 
quinine. According to Binz, quinine is elimin- 
ated chiefly by the kidneys, but also by the sal- 
ivary, sudoriferous and mammary glands. 
Usually, within half an hour after a large dose 
has been taken, it makes its appearance in the 
urine and its elimination continues for two or 
more days. 

Quinine does not occupy the prominent place 
in alkaloidal medication, that it does in the older 
methods. This has been shown by the publica- 
tion of twelve prize lists of the twelve most use- 
ful medicines in dosimetry. These lists were 
prepared by different physicians residing in dif- 
ferent parts of the United States and in only one 
of them was quinine mentioned. 

As an antipyretic, quinine occupies a minor 
place. There are other remedies, as aconitine, 
digitalin and veratrine, which reduce fever, 
"quickly, safely and agreeably." In the treat- 
ment of all kinds of fever, quinine may be given 
in conjunction with other medicines, because of 
its tonic effect. Burggraeve has established the 
excellent rule of giving arseniate or hydro-ferro- 
cyanate of quinine and arseniate of strychnine 
after fever has been reduced by other means. 
Besides its tonic effect, it also prevents 
relapses. 



i 5 6 QUININE. 

In the treatment and cure of malarial diseases, 
quinine produces its most important therapeu- 
tical effect. Its action in these cases is so per- 
fect as to make it, not only the chief of remedies 
of its class, but, also, a specific. Arseniate of 
quinine is best suited for the treatment of these 
diseases. This salt contains 74 per cent of 
quinine, 10.6 per cent of arsenic and 15.4 per 
cent of water. The arsenic contained in this prep- 
aration undoubtedly aids the quinine in neutral- 
izing the malarial poison and, therefore, in affect- 
ing a cure. On account of the arsenic, the dose, 
necessarily, must be small. The arseniate does 
not derange the stomach, like the usual doses of 
other salts of quinine, and its contra-indications 
are few. 

In the treatment of intermittent fevers, two 
granules of arseniate of quinine, each containing 
one-sixth of a grain, should be given every two 
hours, while in remittent fever two granules 
should be given every hour. In the pernicious 
or congestive form of malarial fever, the chill 
should be anticipated, if possible, and three or 
four granules of atropine sulphate, gr. 1-250 
each, should be injected subcutaneously. If 
coma or vomiting exist, one or two grains of 
hydrobromate of quinine should be injected, hy- 
podermically, every hour until there are evi- 
dences of improvement, or until some physiolog- 
ical effect of the medicine is produced. Phy- 
sicians who practice in malarial districts should 



QUININE. 157 

be prepared to treat, hypodermically, this very 
fatal form of malarial fever. 

The doses of quinine recommended must, 
necessarily, seem very small to those physicians 
who are in the habit of prescribing from twenty 
to forty grains in one or two doses. According 
to Burggraeve, Castro and others — and their 
opinions can be substantiated by the writer as 
well — all forms of malarial fever, even the most 
pernicious, can be cured dosimetrically. If 
cinchonism is necessary, it may be produced by 
giving small doses of quinine frequently re- 
peated. It is of the greatest importance to pre- 
vent the chill, if possible, by the administration 
of atropine, and to give arseniate of strychnine 
and of quinine during the stage of apyrexia. 

It is the custom, with many practitioners of 
medicine, to give a full dose of calomel, grs. 10, 
as early as possible in the treatment of malarial 
diseases, and to give ten or twenty grains of 
quinine about four hours before the time of the 
expected chill. In dosimetry, as in everything 
else, we are likely to hold fast what has proved 
good. If physicians have been accustomed to 
use large doses of quinine, and have cured their 
patients, it is probably best to continue this prac- 
tice. If, however, large doses fail to cure, small 
doses should be tried, as recommended above. 

Quinine is also used in the treatment of all 
kinds of neuralgia, but it is best adapted to 
those cases which manifest most periodicity. In 



i 5 8 QUININE. 

simple neuralgia, of anemic patients, the hydro- 
ferrocyanate may be used; in neuralgia of mala- 
rial patients, the arseniate is preferred; while 
in neuralgia of rheumatic patients, the salicy- 
late is indicated. 

When nervous disorders are of malarial origin, 
as chorea and asthma, hydrobromate or valer- 
ianate of quinine should be used. Quinine is 
probably given more frequently, and is used in 
the treatment of a greater variety of diseases, 
than any other medicine. The habit of pre- 
scribing quinine has grown so strong with some 
practitioners, that they have become routinists. 
Fortunately, quinine can do no harm in small 
doses, but acts as a stomachic tonic, and increa- 
ses the functions of the heart and brain; conse- 
quently, a course of quinine usually improves 
the condition of any patient. It is always an 
excellent remedy to give when there is no indi- 
cation for the use of any particular medicine. 
As has been aptly said, " when you don't know 
what to give, give quinine." 

In the treatment of disease, especially of a 
serious nature, medicine rarely cures unless it 
produces some physiological effect. This may 
not always be apparent but, nevertheless, it oc- 
curs. In the treatment of serious, malarial 
diseases, the writer believes it is necessary to 
push the quinine treatment until there are evi- 
dences of improvement or until fullness of the 
head, or tinnitus aurium, is produced. In the 



QUININE. 159 

treatment of milder cases, prominent symptoms 
are often relieved before the physiological effects 
of the medicine have been produced. 

When a remedy is indicated, we are justified 
in continuing its use until some effect upon the 
system is manifested, but we should not pro- 
ceed beyond the first physiological manifestations. 
We can, if it is necessary, keep the patient 
under the influence of the medicine to this ex- 
tent. This can be accomplished, properly, only 
when medicines are dosimetrically used. In the 
treatment of malarial diseases of adults, one, two 
or three granules of arseniate of quinine, gr. 1-6 
each, should be given every one, two, or three 
hours, according to the severity of the attack. 
The remedy should be persevered in until some 
improvement is observed or until ringing in the 
ears is produced. The same dose should then be 
given every three or four hours. For children, 
granules containing 1-67 of a grain should be 
used. 



^QyO^> 



CHAPTER XXVIII. 

SCILLITIN (GLU.). 

Standard granule — Gr. 1-67, grm. .001. 

Dose — Two or three granules every one or two hours. 

Scillitin is the active medicinal principle of 
scilla, or squills. Scillitin is an expectorant 
and a diuretic. In acute or chronic bronchitis, 
where the sputum is tough and difficult to expec- 
torate, the tenacious mucus is liquified and the 
cough is made easier by the administration of 
scillitin. Emetine and scillitin make an excellent 
combination for bionchitis. 

In the treatment of dropsies, not dependent 
upon acute nephritis, scillitin is extensively used 
and it increases the quantity of urine. Caffeine 
and digitalin may be added to it with advantage. 
The dose for adults is two or three granules, to 
be taken every one or two hours. For children, 
from one to five years of age, from five to ten 
granules may be dissolved in twenty-four tea- 
spoonfuls of water, and one teaspoonful given 
every hour. In large doses scillitin irritates the 
gastro-intestinal mucous membrane and pro- 
duces vomiting and diarrhoea. It also irritates 
the kidneys and bladder, producing bloody- 
urine and stranguary. It is contra-indicated, there- 
fore, in inflammatory conditions of the alimen- 
tary canal and inflammation of the kidneys. 



CHAPTER XXIX. 

SEIDLITZ SALT. 

Standard granulation — Fifty per cent dehydrated mag- 
nesium sulphate. 

Dose — One to four or more drams, as needed. 
" Seidlitz salt is composed of dehydrated and 
purified sulphate of magnesia, associated with 
a small quantity of bicarbonate of soda and tar- 
taric acid to make it slightly effervesent, and to 
facilitate its absorption. It is granulated by- 
means of pure white sugar." — Burggrceve. 

The action of seidlitz salt is that of a mild 
aperient, and it can be taken by persons of the 
most delicate constitution. If there is one thing 
which Burggraeve emphasizes more than any 
other, it is that this salt should be given in all 
diseases; in both acute and chronic cases this 
is usually a good rule to follow. 

In acute febrile diseases, the gastro-intestinal 
secretions are usually checked, and constipation 
is the result. The fecal matter, thus retained 
within the intestines, under the influence of the 
increased heat of fever, readily undergoes fer- 
mentation The poisonous materials and gases 
formed, not having an outlet, must be absorbed 
into the blood and toxaemia is the result. When 



162 SEIDLITZ SALT. 

this occurs, there is foul breath, a bad taste in 
the mouth and frontal headache. 

Sometimes febrile diseases have, as their sole 
cause, this condition of constipation. The fever 
is produced entirely by the absorption of the 
products of intestinal decomposition. A cure 
of these cases immediately follows the action 
in an aperient. This clearly demonstrates 
the absurdity of one of the injunctions of homoe- 
opathy, viz., never to use cathartics; no mat- 
ter how distended the abdomen, how long con- 
stipation has existed or how foul the breath and 
tongue may be, a true disciple of Hahnemann 
would never give an intestinal evacuant. 

Not only is the fecal matter removed by the 
action of a saline aperient, but the accumulated 
mucus is removed from the lining membrane of 
the gastro-intestinal tract, and a better secretion 
produced, which must greatly improve the ab- 
sorbing power of the stomach and intestines. 

In all febrile diseases, therefore, a teaspoonful 
of seidlitz salt given in half a glassful of water, 
insures quicker absorption and better action of 
the medicine given. 

In the treatment of children a tablespoonful 
of the above solution may be given ever) 7 two or 
three hours. 

One of the most important auxiliaries in the 
treatment of intestinal diseases of children, dur- 
ing summer months, is seidlitz salt. Cholera 
infantum, gastro-enteritis and entero-colitis are 



SEIDLITZ SALT. 163 

usually produced by the presence of decompos- 
ing food within the alimentary tract. Improve- 
ment cannot occur so long as fermenting mate- 
rial remains, and one of the best evacuants is 
seidlitz salt. 

While seidlitz salt is not identical in composi- 
tion with the well-known seidlitz powder, its ac- 
tion and result are at least similar, and seidlitz 
salt may be used in all cases which usually call 
for seidlitz powders. The great value of the 
latter aperient is very well known to the laity, as 
a means of cooling the fevered stomach and 
clearing the muddled brain after a spree. This 
accounts for the large- sale of seidlitz powders on 
Mondays. 

In the treatment of chronic diseases, seidlitz 
salt is an important remedy with which to empty 
the intestinal tract. Patients improve much 
more rapidly if the bowels move every day. In 
the treatment of pelvic diseases of women, a 
teaspoonful of seidlitz salt every morning aids 
very greatly in relieving congestion and in sub- 
duing inflammation. 

All saline cathartics stimulate the functions of 
the kidneys and of the skin, so that seidlitz salt 
increases the activity of the most important 
excretory glands, whereby the elimination of 
toxic materials is facilitated. In the treatment of 
gout and of rheumatism, a daily dose of seidlitz 
salt very greatly aids colchicine in eliminating 
uric acid and urates. 



CHAPTER XXX. 

SPARTEINE (ALK.). 

Standard granule — Of the sulphate, gr. 1-67, grm. .001. 

Dose — Two to three every two or three hours. 

The tops of cystisus scoparius, or broom, con- 
tain two active principles. One is scoparin, 
which probably represents the diuretic and dras- 
tic properties of broom, and the other is spar- 
teine, which represents the heart-tonic properties 
of the plant. 

The most desirable preparation is a neutral 
sulphate; this is similar in its action to 
digitalin and, in common with other cardiac rem- 
edies, may be used in all cases in which the 
latter is indicated. It is not so powerful a rem- 
edy as digitalin, but it has the great advan- 
tage of acting very rapidly, usually within thirty 
minutes, and, besides, its effects are more 
lasting. 

The diuretic properties of sparteine are not so 
marked as those of digitalin but, incases in which 
the cardiac movement is feeble and irregular, and 
the urine is scanty, it may be used with good effect; 
in dropsies of renal or hepatic origin, however, 
this remedy is of no value. In palpitation produced 



SPARTEINE. 165 

by functional derangement, accompanied by pain, 
sparteine is probably the best and most rapidly 
acting of heart remedies. It relieves the pain 
and regulates the arhythmical action of the heart. 

In organic affections of the heart, it is of the 
greatest value in the treatment of mitral regurgi- 
tation, and it affords relief in asthma, and also 
in cedema when produced by cardiac diseases. 
Sparteine does not act upon the vaso-motor 
centers as does digitalin and, therefore, the 
arterioles do not contract or relax, under its 
influence, neither is there marked increase of the 
blood-pressure. 

In all cases it is best to begin treatment with 
small doses of sparteine. Two or three granules 
may be given every hour, and if improvement is 
manifested the dose should then be given every 
two or three hours. In painful affections of the 
heart, not inflammatory, accompanied by palpita- 
tion, if relief is not obtained within twenty-four 
hours the dose should be gradually increased to 
one-half of a grain, which may safely be given 
every three or four hours. 

In aortic regurgitation, according to Clarke, 
smaller doses are required than in the treatment 
of mitral disease. 



CHAPTER XXXI. 

STROPHANTHIN (GLU.). 

Standard granule — Gr. 1-500, grm. .000125. 

Dose — Two granules every half to two hours. 

Strophanthin is obtained from strophanthine 
hispidus. It does not contract the arterioles, 
but in all other respects it is similar in its action 
to digitalin. In the majority of cases it is in- 
ferior to digitalin but, sometimes, it may produce 
good results even after digitalin has failed to 
produce any improvement in the patient. In 
such cases strophanthin, sparteine, convallamarin 
or cactin may each be given a trial, or combi- 
nations may be made of these similarly-acting 
remedies. 

Strophanthin acts directly upon the heart-mus- 
cle, and produces a more vigorous and pro- 
longed contraction. The heart's action is, 
thereby, made slower and more regular, and the 
pressure within the blood-vessels is increased. 

This medicine is, therefore, recommended 
when the pulse is feeble, easily compressed and 
intermittent, especially when these symptoms 
occur in cases of typhoid fever or in pneumonia, 
or when the patient has been under a severe and 



STROPHANTHIN. 167 

prolonged mental or physical strain, or when 
tobacco has been used to excess. 

It is further successfully employed in cede ma, 
especially when occurring in the lungs as a re- 
sult of mitral stenosis or insufficiency and of 
dilatation of the right ventricle. Not only have 
dropsical effusions, in the cellular tissue, been 
rapidly removed by the administration of stro- 
phanthin but, also, those of the serous cavities. 
In relieving these conditions, strophanthin acts 
as a diuretic by increasing the blood-pressure and, 
probably, by stimulating the renal epithelium. 
In acute nephritis, this remedy seems to act 
injuriously, by increasing the inflammation of the 
kidneys, but in chronic nephritis with oedema, 
it produces good results. 

One of the excellent qualities of strophanthin 
is that it acts quickly; its effects are observed 
within half an hour. The dose of strophanthin 
is two granules every half hour, when a rapid 
action is desired. When improvement in the 
patient's condition is manifested, the dose should 
be given every two hours. In chronic cases two, 
three or four granules may be given every three 
hours, and the dose may be increased or dimin- 
ished as necessity requires. 



CHAPTER XXXII. 

STRYCHNINE (ALK.). 

Standard granule — Gr. 1-134, grra. .0005. 
Dose — One to six three times a day, or one every half 
to one hour under special conditions. 

Strychnos nux-vomica contains two alkaloids, 
strychnine and brucine. The yield of strych- 
nine is from 1-4 to 1-2 per cent, while that of 
brucine is 0.12, per cent. 

These two alkaloids are similar in their action, 
but brucine, being much milder, is preferred 
when prescribing for children. The following is 
the list of alkaloidal granules prepared from the 
various salts of strychnine: The arseniate, gr. 
1-134, grm. .0005; hypophosphite, gr. 134, grm. 
.0005; nitrate, gr. 1-67, grm. .001; sulphate, gr. 
1-134, grm. .0005, and the valerianate containing 
gr. 1-134, grm. .0005. 

In dosimetric practice the arseniate is more 
frequently used than any other salt. Its chemical 
composition is as follows. Strychnine 72.5 per 
cent, arsenic 12 percent, water 15.5 percent. 

According to Bartholow, "The effects of 
strychnine are exerted on the spinal cord, on the 
seat of motor function." "When taken in quan- 
ities just sufficient to produce sensible physiolog- 



STRYCHNINE. 169 

ical effects, strychnine induces, in man, a feeling 
of restlessness, perhaps accompanied by tremb- 
ling in the limbs and some stiffness in the neck 
and jaws. When a somewhat larger amount 
has been taken, there may be general, muscular 
twitchings and startings with stiffness and 
stricture of the throat and chest." — H. C. 
Wood. 

It is sometimes necessary, in the treatment of 
neurasthenics and others, to push the adminis- 
tration of strychnine until the first physiologi- 
cal effects are produced, before any impression 
can be made upon the case. To produce this 
effect, two granules of the nitrate, gr. 1-67 each, 
may be given every hour until a feeling of stiff- 
ness in the neck and jaws is perceived; one-half 
of the dose may then be continued every two 
hours. 

One-twelfth of a grain of strychnine, taken in 
a single dose, will produce, in a majority of per- 
sons, some physiological effect, which is usually 
manifested within half an hour. When giving 
strychnine for the above purpose, it is best to 
administer it in solution. In cases of accidental 
poisoning or attempted suicide by means of 
strychnine, hydrate of choral is the best 
antidote, after the stomach has been evac- 
uated. 

Strychnine is an exceedingly bitter medicine. 
When it is taken through the mouth, its 
first action is to augment the secretions of the 



170 STRYCHNINE. 

stomach and intestines and to increase peristalsis*. 
It maybe used, therefore, during convalescence; 
to restore the appetite in dyspepsia; to promote 
better digestion by increasing the quantity of 
gastric juice and to overcome constipation, by 
increasing intestinal secretion and by stimulat- 
ing the muscles to more vigorous peristalsis. 

Strychnine is a useful adjunct to all cathartics. 
It should be used, especially, in constipation 
of the aged, or in those individuals who take 
little or no muscular exercise. In all reflex vomit- 
ing, especially in pregnancy, one granule of -the 
hypophosphite of strychnine, given every hour, 
frequently cures the patient. In the morning 
vomiting of drunkards, two granules of the ar- 
seniate and two of arseniate of soda will often 
procure relief. 

In poisonous doses, strychnine produces death 
by paralysis of the respiratory muscles but, in 
small doses, it is a powerful respiratory stimu- 
lant. In all chronic lung diseases, where the 
patient is unable to exercise sufficient muscular 
power to completely expel the mucus, two or 
three granules of strychnine arseniate, s^iven every 
two hours, will often produce surprising results. 



*This is due, in a great measure, to the intensely bitter 
taste. We often make use of this in atonic conditions of 
the digestive organs, by giving the granules in solution at 
frequent intervals. For this purpose small doses suffice, 
three or four granules in half a glass of water being all 
that is necessary. 



STRYCHNINE. 171 

In the vomiting of phthisis, Bartholow considers 
strychnine as the most effective of all medicines. 

Upon the heart, strychnine is a very potent 
stimulant, it increases the tone and strength of 
its action, contracting the arterioles and raising 
the blood-pressure. Strychnine is one of the 
most useful of all heart-tonics and stimulants, 
and should be used in all cases where there is 
irregular or feeble cardiac action, especially in 
asystolia and dilation, and in those chronic forms 
of heart disease in which digitalin, cactin, spar- 
teine and other heart remedies, after a most faith- 
ful trial, fail to make any impression upon the 
diseased organ. In these cases, it is best to ad- 
minister strychnine in doses of three or four 
granules every two hours, not with much hope 
of effecting a cure, but for the reason that it is 
the best medicine that can be given to sustain 
life as long as possible. 

Strychnine is the most useiul general tonic, 
and the most powerful incitant of the vital func- 
tions, that we possess. There is no depressed 
state of the system in which strychnine is not in- 
dicated, and in which it may not be used to ad- 
vantage. During the prodromal stage of fevers, 
when the temperature is abnormal, and when 
general depression exists, no remedy can so 
effectually restore the patient to his normal con- 
dition as strychnine and phosphoric acid, given 
in doses of one or two granules of each, 
every half hour. This method of treat- 



172 STRYCHNINE. 

ing the precursory stage of fever origin- 
ated — as did many other good things — with 
the learned master, Burggraeve, and has proved 
to be of great efficacy. 

Throughout the course of all fevers, strychnine 
is one of the most useful remedies, because it 
sustains the heart and keeps up the tone of the 
nervous system. For this reason it has been 
added to the defervescent remedies and, in com- 
bination with them, forms granules, known as 
"Defervescent Compound" and "Dosimetric 
Trinity." If medicines do not produce their 
usual and expected results, through failure to 
make an impression upon the nerve centres be 
cause of a low degree of vitality, strychnine will 
stimulate the nerve tissue and arouse it from the 
depression produced by disease, so that, when 
other medicines are administered, they are more 
efficient in their action. 

It may be said, then, that in the treatment of 
all diseases better and quicker results are ob- 
tained from other medicines when strychnine is 
given therewith. In the treatment of malarial 
diseases, quinine is made more potent if given 
with arseniate of strychnine. In the treatment 
of many cases of atonic diarrhoea, dysentery, and 
cholera, improvement does not occur until 
strychnine is administered. 

The action of digitalin is greatly increased 
when combined with strychnine. Digitalin 
sometimes fails to effect a cure when given alone 



STRYCHNINE. 173 

but, as soon as strychnine is used, improvement 
is manifested. This is true, also, of all heart- 
remedies. Strychnine is needed, in connection 
with them, to energize the cardiac nerves and 
muscles. " Strychnine exalts all the functions 
of the spinal cord — reflex, motor, vaso-motor and 
sensory — the latter being least affected. " — Potter. 

Strychnine is a remedy which, in its effect up- 
on the nervous system, closely resembles the 
action of electricity. There is better receptiv- 
ity and conductivity; there is increase of nerve 
energy and this energy is imparted to the vol- 
untary and involuntary muscles causing them to 
respond and contract with more vigor. This 
influence upon the muscles is particularly shown 
when strychnine is administered in cases of par- 
tial or complete paralysis, and in cases of uter- 
ine inertia. In incontinence of urine, also when 
retention is the result of paralysis and when con- 
stipation is produced by absence of peristalsis, 
strychnine is a most useful remedy to restore 
irritability and contractibility to the paralysed 
involuntary muscles. 

This action is still further shown when, in case 
of labor, the uterine contractions are feeble, or 
have ceased altogether; vigorous contractions 
may be induced by injecting, hypodermically, 
1-30 of a grain of nitrate of strychnine, or by ad- 
ministering two granules of the hypophosphite 
every half-hour until ten granules have been 
taken. 



174 STRYCHNINE. 

If post-partum hemorrhage is anticipated (it 
having previously occurred in a given case or be- 
cause of the flabby condition of the uterus), 1-30 
of a grain of the nitrate of strychnine should be 
given sub-cutaneously, and this should be re- 
peated, if necessary, within half or one hour. 
As soon as the placenta has left the uterine cavity, 
two or three grains of ergotin should be admin- 
istered hypodermically; and this should be re- 
peated every half hour until permanent uterine 
contraction is assured. 

It is one of the tenets of dosimetry, that any 
unfavorable tendency of the disease should be an- 
ticipated by the early application of remedies, in 
order to prevent its occurrence. Post-partum 
hemorrhage should be anticipated, when, in pre- 
vious labors, uterine contractions have been 
feeble and the loss of blood considerable. In 
these cases, strychnine should be administered 
more or less continuously, during the entire per- 
iod of gestation. Two or three granules of the 
arseniate may be given three times a day for one 
month, then for one or two weeks give quinine 
and iron granules, when strychnine may be again 
resumed in the form of the hypophosphite and 
administered for several weeks. This method, 
or one similar to it, should be followed and the 
result will be more vigorous uterine contrac- 
tions. 

The paralysis accompanying capillary bron- 
chitis, diphtheria and peritonitis, should also be 



STRYCHNINE. 175 

anticipated and prevented, by giving strychnine 
throughout the course of the disease. When 
given in peritonitis, it prevents distension of the 
intestines, or tympanitis, a condition which is 
always dreaded and is very difficult to overcome. 
In this disease two or three granules of the hypo- 
phosphite may be given every two hours. If it 
has not been given from the onset of the attack, 
as a preventive, it may be administered, even 
if tympanitis is marked, with the hope of induc- 
ing contraction of the intestines and expulsion 
of the gas. 

It is much more rational to anticipate the fatal 
tendencies of disease, and to prevent them by 
appropriate medicines, than to wait until they 
have made their appearance. 

To postpone the administration of strychnine, 
in capillary bronchitis, until, with each inspiration, 
there is sinking of the abdominal wall along the 
margin of the ribs, is absolutely wrong. Good 
results cannot then be accomplished, paralysis 
has already set in and even strychnine fails to 
stimulate nerve tissue which has been poi- 
soned by carbonic acid gas. Strychnine is a 
valuable remedy to use in the treatment of par- 
alysis, especially when it follows in the course of 
diphtheria, rheumatism, malaria and lead-poison- 
ing. In paralysis of long standing, where muscles 
no longer respond to the application of elec- 
tricity, this remedy is useless. 

When impotence is due to sexual excesses, 



i 7 6 STRYCHNINE. 

and there is lack of muscular tone, two granules 
of arseniate of strychnine and two of phosphoric 
acid, given every three hours, will, in the course 
of a few weeks, effect a cure. No remedy is so 
strongly indicated in surgical shock and in col- 
lapse as strychnine, but only in very large doses. 
According to Hare, "not less than 1-20 of a 
grain should be employed, hypodermically, every 
half hour." 

Strychnine is such a strong stimulant, that 
the writer never finds it necessary to prescribe 
alcohol in any form and, during years of very 
active professional life, he has learned that it is 
possible to practice medicine very successfully 
without using it at all. In cases of typhoid 
fever and pneumonia, where whisky and brandy 
are most frequently used, it has been demon- 
strated that patients recover more rapidly, and 
are in a better condition at the end of the disease, 
without alcohol than with it. 

The prescribing of alcoholics has become a 
habit and, like all habits, excuses are easily 
made for it. The majority of adult patients 
are fond of alcoholic drinks and physicians 
usually strive to please their patients. Strych- 
nine replaces alcohol. It is a true tonic and 
stimulant and is free from the evil tendency of 
forming a habit. It may be used in all cases of 
emergency where whisky is generally prescribed. 

As a substitute for alcoholic liquors, the won- 
derfully stimulating powers of strychnine are dem- 



STRYCHNINE. 177 

onstrated, when it is administered to one who 
has been surfeited with drink and the usual 
glass of liquor fails to awaken a response, or to 
make an impression. That is, the customary 
drink does not steady the trembling, palsied 
body, clear the benumbed brain, or loosen the 
paralyzed tongue. In these cases, even the 
stomach is rebellious and rejects the favorite 
drink, and the shattered nervous system no 
longer exercises its controlling influence. Hy- 
pophosphite of strychnine is the only remedy 
that can still arouse the alcohol-soaked brain 
and restore the narcotized and almost useless 
mass to its former high position as ruler. 

This wonderful medicine can be used, 
not only as a restorative but, also, as a 
preventive against the use of liquors. 
There is an unfortunate, diseased class of 
people, who abstaining from intoxicating drinks 
for weeks and months, after a variable period 
become restless, nervous and dissatisfied with 
themselves and their surroundings and pos- 
sessed with a desire, a thirst, an irresistible crav- 
ing; they drink, and by the attempt to satisfy this 
unsatiable thirst they become drunk, and remain 
so for days until nature is exhausted and ends it 
all in a prolonged sleep, or in an attack of de- 
lirium tremens. 

If these unfortunate creatures could know, 
that, when this restlessness first comes on, a hy- 
podermic injection of 1-30 of a grain of nitrate 



i 7 8 STRYCHNINE. 

of strychnine, administered once or twice daily, 
would so tone the nervous system and subdue 
the restlessness, that the stage of irresistible thirst 
might never be reached, if they could know 
this, I repeat, many a man, yes, many a woman 
would be saved from a periodical spree. 

It is the duty of every physician to make a 
trial of this remedy, for the purpose of prevent- 
ing drunkenness, in all cases over which he has 
control. Like all remedies, this one may fail 
sometimes but it is usually successful. 



^yO"^ 



CHAPTER XXXIII. 

VERATRINE (ALK.). 

Standard granule — Gr. 1-134, grm. .0005. 
Dose — One every half to one or two hours. 

Veratrine is prepared from the seeds of saba- 
dilla and was discovered by Meissner in 1819. 
While veratrine is similar in its action to vera- 
trum viride, it is not the active principle of this 
plant, which is represented, principally, by the 
alkaloids cevadine and jervine. 

In dosimetric medicine veratrine is prepared 
in granules containing 1-134 of a grain, gram 
.0005. It also enters into the granules known 
as " Defervescent Compound No i."and "No. 
2." Defervescent Compound No. 1. contains 
aconitine amorphous, gr. 1-134, grm. .0005, 
digitalin Germanic, gr. 1-67, grm. .001 and vera- 
trine gr. 134, grm. .0005; Defervescent Compound 
No. 2. contains one-fourth the quantity of No. 1. 

The dose of veratrine recommended in the 
National Dispensatory ranges from gr. 1-60 to 
1-4. In dosimetric practice one granule is the 
dose, which may be repeated every half hour 
until improvement is observed. Veratrine is 
used chiefly in the beginning of acute diseases, 



180 VERATRINE. 

and particularly in pneumonia and rheumatism. 
Care should be taken, always, to note that the 
patient's heart is strong. Its effects, when ad- 
ministered in sthenic, febrile cases is, to lower 
the pulse and temperature, to reduce the vigor- 
ous action of the heart and to increase the secre- 
tions. When thus given, early in the course of 
acute diseases, jugulation is frequently the 
result. 

Large doses from " gr. 1-60. to gr. 1-4," 
should never be given. This is, in reality, 
" making the remedy worse than the disease." 
Such a dose would produce, in the majority of 
patients, violent vomiting, possibly purging and 
prostration. The vomiting produced by verat- 
rine is its safe guard against poisoning. If too 
large a dose is taken, emesis follows and the 
medicine is rejected before harm results. There 
is never any occasion for these large doses. 
One granule, gr. 1-134, given every half hour, 
will gradually produce, in the course of a few 
hours, the full effect of the remedy. If vomit- 
ing should occur, the medicine can be given at 
longer intervals. 

Defervescent Compound No. • 1. is, probably, 
the most powerful combination that can be 
formed with which to combat acute, active fever. 
There need be no hesitancy in giving this gran- 
ule to a strong patient, whose pulse and heart is 
bounding vigorously. When the temperature is 
105 degrees, one granule may be given every 



VERATRINE. 181 

fifteen minutes and, as improvement is observed, 
the dose may then be given every hour. Vera- 
trine is sometimes given to allay pruritus, which 
accompanies cutaneous diseases. One granule 
given every two hours is sufficient. 



*QyO*^y 



CHAPTER XXXIV. 

ZINC SULPHOCARBOLATE. 

Standard granule— Gr. 1-6, grm. .01. 
Dose — One-sixth grain to five grains, according to indi- 
cations. 

Sulphocarbolate of zinc is made by decompos- 
ing a solution of barium sulphocarbolate with 
zinc sulphate. In dosimetric medicine, it is pre- 
pared in granules containing 1-6 of a grain, and 
it can also be obtained in tablets containing one 
grain or two and one-half grains. 

The older one grows in the practice of med- 
icine, the greater will be the tendency to confine 
oneself to the use of a few tried and trusty rem- 
edies. From a small number of reliable medi- 
cines, rarely exceeding twelve, selected during 
years of experience from thousands of remedial 
substances, practical physicians make various 
combinations, by means of which they can 
alleviate suffering and cure disease. It is of 
great importance, in a successful medical prac- 
tice, that the physician should have the utmost 
confidence in the remedies which he employs; 
and, not only must he have confidence himself, 
but he should also be able to instill his confi- 



ZINC SULPHOCARBOLATE 183 

dence into his patients; his success is then assured. 
One remedy, sulphocarbolate of zinc, has 
won the utmost confidence of the writer, through 
a very extensive experience. Living, as he does, 
in a large and crowded city, which, during the 
summer months, is one of the hottest places in the 
country, ample opportunity is, therefore, offered 
him to test this preparation thoroughly, in the 
treatment of such diseases as cholera-morbus, 
cholera-infantum and diarrhoea. 

The heat of summer not only depresses the 
individual and lowers his power of resisting dis- 
sease, but it also produces such changes in his 
food as render it unfit for consumption, and 
makes it a fruitful source of alimentary disorders. 

Gastro-intestinal diseases are almost invarably 
produced by unwholesome food and drink, which 
cannot be properly acted upon by the digestive 
fluids and rendered harmless. They, therefore, un- 
dergo fermentation, evolve «gases and form acids, 
which distend and irritate the gastro-intestinal 
canal, and produce pain, vomiting and diarrhoea. 
If the irritation is severe, all of these symptoms 
may be present at the same time. Vomiting 
or diarrhoea are the results of nature's effort to 
get rid of this decomposing food but, even after 
it has been expelled, there frequently remains 
an irritable condition of the stomach and intes- 
tines which may continue for days. 

In the treatment of gastro-intestinal disease, 
the first symptom which requires attention is 



184 ZINC SULPHOCARBOLATE. 

pain. If this is severe, and the patient is an 
adult, a hypodermic injection of morphine and 
atropine should be administered. If the pain is 
not severe three granules of zinc and three gran- 
ules of codeine, gr. 1-6, should be given every 
half hour. Three granules of zinc and one of 
hyoscyamine is also an excellent combination to 
be used for the relief of pain. When the patient 
begins to improve, the medicine should be given 
every one or two hours. A recently devised 
tablet, containing, zinc sulphocarbolate, codeine 
sulphate, and hyoscyamine apomorphous, with 
strychnine sulphate, meets all these indica- 
tions admirably. 

If vomiting is the most prominent feature 
of the disease, so that even the medicine is re- 
jected, a hypodermic injection of morphine and 
atropine will relieve this annoying symptom. 

If this means is not used, the same result may 
frequently be attained by giving the patient 
small pieces of ice to suck, by giving teaspoon- 
ful doses of lime water, by applying a mustard 
plaster to the epigastrium, or by giving one half 
grain doses of sulphocarbolate of zinc every half 
hour. This latter remedy frequently checks 
vomiting with surprising promptness. The 
worst forms of vomiting and diarrhoea are often 
cured by giving sulphocarbolate of zinc alone. 

The diarrhoea accompanying phthisis and 
typhoid fever are almost invariably checked, by 
taking doses containing one or two grains of 



ZINC SULPHOCARBOLATE. 185 

this remedy, every two hours. In typhoid fever, 
as suggested by Waugh, zinc is one of the best 
remedies to administer throughout the entire 
course of the disease; it prevents fermentation, 
checks diarrhoea and renders the intestinal canal 
aseptic. Sulphocarbolate of zinc is one of the 
best and safest intestinal antiseptics and astring- 
ents with which we are acquainted. Its virtue as 
an antiseptic depends upon the carbolic acid it 
contains, which is rendered less irritating in this 
combination than in its pure state, while its as- 
tringency is due to the zinc in its combination. 

Zinc is a remedy which should be given a trial 
in the treatment of all forms of diarrhoea but, 
especially, in those cases caused by fermentation 
as is shown by mushy and frothy stools. In intes- 
tinal indigestion, when pain and stools occur 
several hours after ingestion of food, one or 
two grains of zinc sulphocarbolate, given with 
each meal, frequently produce a cure. 

But even this excellent remedy sometimes 
fails, as shown in one very obstinate and persis- 
tent case of diarrhoea (the cause of which was 
not apparent) which resisted every kind of treat- 
ment; not only the older, "orthodox" methods, by 
means of bismuth, tannic and sulphuric acids, 
acetate of lead, opiates and salol, but even dosi- 
metric treatment by means of zinc, copper 
arsenite, and others. Improvement began, how- 
ever, as soon as strychnine arseniate was admin- 
istered and, from that time, the patient made 



186 ZINC SULPHOCARBOLATE. 

a rapid recovery. Some remedy was required 
which could awaken and stimulate the dormant 
nerve power and make it respond to medicinals. 
The diarrhoea, which best yields to strychnine, is 
of the kind that may be called passive; the stools 
occur without any muscular action; they flow 
from the patient without his cognizance. 

While sulphocarbolate of zinc is an excellent 
remedy in the treatment of the diarrhoea of adults, 
its chief therapeutical value is manifested when 
used in the treatment of intestinal diseases of 
infants and children. The writer always uses 
zinc in the treatment of diarrhoea, sometimes 
alone but, frequently, in combination with codeine 
or hyoscyamine. The case must be one of extra- 
ordinary severity which cannot be cured by these 
remedies. 

In treating cholera-infantum and diarrhoea of 
infants, sulphocarbolate of zinc should always be 
given in solution. It is a remedy which infants 
bear exceedingly well. A child a month old 
may be given a granule, gr. 1-6, every half hour, 
or every hour and, strange as it ma)* appear, it 
has not been found necessary to increase the 
dose for children under one year. The remedy 
is not poisonous, and it is not necessary to use 
the same precaution that must be used in pre- 
scribing dangerous medicines. 

In excessive doses it acts like sulphate of zinc 
and, therefore, produces vomiting. When this 
occurs, it is an evidence that the dose has been 



ZINC SULPHOCARBOLATE. 187 

too large and should be diminished. The fol- 
lowing prescription will be found proper and 
useful in the treatment of gastro-intestinal dis- 
ease in children under one year of age: Four 
grains of sulphocarbolate of zinc, or twenty-four 
granules, may be dissolved in twenty-four tea- 
spoonfuls of water. A teaspoonful of this solu- 
tion should then be given every half hour or 
every one, two, or three hours, according to the 
severity of the attack. If there is much fever, 
one or two granules of amorphous aconitine, 
gr. 1- 1 34, should be added to the above pre- 
scription. 

The vomiting, diarrhoea and pain usually cease 
altogether or, at least, the patient is made to 
feel easier within a few hours. If there is very 
great pain, two, three or four granules of hyoscy- 
amine should be added to the zinc solution and, 
as soon as improvement is manifested, a tea- 
spoonful of the mixture should be given after 
each stool. 

When hard lumps of undigested caseine are 
found in the stools, the diarrhoea and pain are 
produced by the presence of similar masses 
within the intestines. Treatment should then be 
begun by giving a cathartic, either calomel, 
seidlitzsalt or castor oil. 

The patients should be fed on barley for a few 
days, but not on milk, because of the tendency 
of milk, in these cases, to form large coagulations. 
When milk is finally resumed, it is best to mix 



188 ZINC SULPHOCARBOLATE. 

it with barley water and to give pepsin with each 
meal. If the stools are green and contain mucus 
and blood, emetine and zinc are the remedies 
indicated. In there is much straining, and only 
small quantities of mucus and blood are passed, 
castor oil or seidlitz salt should be given 
and, when a normal stool is produced, 
emetine and hyoscyamine may be adminis- 
tered. 

It is a strange and universal characteristic of 
adults, when suffering from gastro-intestinal dis- 
eases, that no matter how much pain or diar- 
rhoea follows eating, they will still continue to 
indulge in their usual diet. Fried potatoes, 
pork, veal, ham and eggs fried hard, boiled cab- 
bage, corn, tomatoes, cucumbers, sausage, cheese 
and coffee are among the most indigestible 
foods. Patients continue to partake of such a 
diet and yet they wonder why they do not get 
better. 

With infants, a similar course is pursued; their 
usual diet is not only persisted in but it is given 
in larger quantities, because of the thirst of the 
patient. Neither do mothers hesitate to feed 
infants upon potatoes, corn and other indiges- 
tible foods. The great wonder is, therefore, 
not that so many infants die, but that so many 
of them live. The most potent of rem- 
edies used in the treatment of diarrhoea, 
are powerless to effect a cure if patients 
indulge in an improper diet. 



ZINC SULPHOCARBOLATE. 189 

The selection of a proper diet is far more diffi- 
cult than is the selection of proper medicines, 
and the best possible means to get rid of this 
vexed question is to order the patient to fast. 
The first thing which a patient, who is suffering 
from diarrhoea, usually says is, " What must I 
eat?" The answer should invariably be, "Noth- 
ing," and the more completely the patient re- 
frains from eating, the sooner will he recover. 
Physicians must impress upon their patients the 
fact that lack of food, for a few days, does not 
result in death by starvation, and that no pos- 
sible harm can come from such abstinence. 
Infants frequently go for a longer period without 
nourishment, and it does not injure them. 

When severe diarrhoea is present,, no matter 
how much food is swallowed by the patient, he 
is, in reality, without nourishment so far as di- 
gestion and assimilation are concerned. The food 
which is given him, is treated, by the stomach, 
as if it were a foreign body; the digestive fluids 
are diminished in quantity and inferior in quality, 
and the food is either rejected by the stomach 
or passed out with the stools unchanged, and 
can be easily recognized. Food given under 
these circumstances cannot benefit the patient, 
but only adds to the difficulty. 

How much more reasonable, then, does it 
seem, to withdraw all food for one or two days 
and give the stomach and intestines a rest. 
While the gastro-intestinal canal is thus empty 



i 9 o ZINC SULPHOCARBOLATE. 

the remedies applied are brought in immediate 
contact with the diseased mucous membrane, 
and are much more effective, and more quickly 
absorbed than when mixed with quantities of 
food. When a patient's knee-joint is inflamed, 
he is, indeed, a poor surgeon who permits him to 
walk and run. When a patient's gastrointesti- 
nal tract is irritable and inflamed, he is a very 
poor physician who permits these structures to 
be kept in action, by vainly attempting to digest 
food. This attempt at digestion is just as irritat- 
ing to the inflamed stomach and bowels, as is 
walking to the inflamed knee. 

What food, then, should the patient take who 
has diarrhoea ? For the first day let him eat no food 
of any kind. If thirst is intense, cold water may 
be given, frequently, in small quantities, or 
pieces of ice may be held in the mouth and al- 
lowed to melt. In treating cases of cholera-in- 
fantum, it is imperative to stop nursing the child 
for one or more days; when this is done improve- 
ment occurs rapidly. Infants should be given 
small quantities of water, or some aromatic tea 
made without sugar. Even in cases that are 
not severe they should not be allowed to nurse 
constantly, but only at stated intervals. They 
cry and fret because of thirst and pain, not be- 
cause of hunger, constant nursing overloads 
their stomachs and only aggravates their con- 
ditipn. After one or two days of fasting, barley 
water may be given, or barley gruel, 



ZINC SULPHOCARBOLATE. 191 

in which lamb or beef has been stewed. 
In making this gruel it is best to use whole 
barley, which can be ground in a coffee-mill; 
after being thoroughly boiled it should be 
strained before it is allowed to cool. This is the 
most easily digested of all foods and as nutrit- 
ious as any. If adult patients tire of barley, the 
white of an egg should be stirred into a glass- 
full of water and slowly baked. This may be 
taken every three hours; smaller quantities may 
be given to children. This is easily digested, 
and is the representative, nitrogenous food. As 
it is almost tasteless adults, and even children, 
drink it without being aware that they are tak- 
ing food. 

Beef tea may also be given. If patients object 
to the extracts found in the market, an excellent 
article can be made according to the following 
receipt: One pound of lean beef should be 
chopped fine and put into one pint of cold water 
and allowed to stand for one hour, then the beef 
and the water should be placed over a slow fire 
and allowed to simmer for two hours, when the 
fluid may be poured off and enough water added 
to make one pint. To this sufficient salt may 
be added to make it palatable and the patient 
may drink it hot, or after it has been placed 
on ice. Oyster stew, made with or without 
milk, may also be given, but only the broth 
should be used. Chicken broth should never 
be given to those suffering from diarrhoea; 



192 ZINC SULPHOCARBOLATte. 

it is very likely to aggravate the disease. 
In the feeding of infants, barley broth should 
first be tried, or some of the artificially prepared 
foods as "Malted Milk," "Wolf's American 
Food," " Liquid Peptones, " or other prepara- 
tions which the physican has found to be useful. 

If cow's milk is fed to infants, it should be 
thoroughly sterilized, not only when given in 
cases of sickness but at all times. Lime water 
may be added to correct vomiting, and barley 
water to prevent casein from forming into hard 
masses. Toast is the only form of bread which 
should be allowed those who have diarrhoea. 
In the process of toasting, some of the starch is 
transformed into dextrine and sugar, and the 
starch granules are ruptured, which makes diges- 
tion easier. While the majority of cases of 
diarrhoea can be cured by a properly selected 
diet or, rather, by fasting and the administration 
of medicine, there are a few cases which cannot 
be benefitted by these means alone, but require 
absolute rest in bed. It is a good plan, when 
diarrhoea continues unabated for one week, to 
put the patient to bed. Rest is an extremely 
useful auxiliary in the treatment of bowel 
disorders. 

Besides the important part which sulphocar- 
bolate of zinc plays in the treatment of gastro- 
intestinal diseases, it has been used as a wash in 
surgical dressing to prevent septicemia. It is 
the one rerr \y used by the writer in the treat- 



ZINC SULPHOCARBOLATE. 193 

ment of ulcerative stomatitis. If there is much 
fever, aconitine is added to a solution of zinc 
as follows: For a child of two years — four 
grains of zinc and three granules of amorphous 
aconitine, gr. 1-134, are dissolved in three ounces 
of water and a teaspoonful is given every half 
hour or every hour. Topical applications may be 
made in severe cases, using ten grains of the zinc 
to an ounce of water. 

As an injection for gonorrhoea, or leucorrhcea, 
in the proportion of one to three grains to the 
ounce of water it will be found to be an effectual 
remedy, after the acute inflammatory symptoms 
have subsided. 



^0^> 



APPENDIX. 

Showing Comparative Dosage of Active Principles as Given by 
Different Authorities. 

Physicians who are just beginning to prescribe the 
alkaloids, invariably entertain a fear that the doses 
they give are too large; contemporary medical teach- 
ing has instilled into their minds a dread of the active 
principles, and as a result they are looked upon as 
very dangerous remedies. A limited experience, 
however, will establish the utmost confidence in their 
efficacy and safety, when used in accordance with the 
teachings of "dosimetry." 

Hoping to reassure the timid, the following Hst of 
remedies has been prepared, showing the size of the 
dose as prescribed by orthodox physicians, and giving 
the standard alkaloidal granule as well. The numer- 
als given are grains or fractions of a grain, so the 
" gr. " has been omitted. The works referred to are 
"National Medical Dictionary " by John S. Billings; 
"Notes on Newer Remedies" by David Cerna; 
Gould's "Illustrated Dictionary of Medicine" and 
standard dosimetric works of Burggraeve, Castro and 
others. 



Drug Name. 


Billings. 


Cema. 


Gould. 


S. G* 


Aconitine, 

crystalline . . 
Aconitine, 

amorphous. . 


1-400 to 1-300 






1-500 

1-134 
1-67 
1-67 
1-67 
1-67 
1-67 




1-200 to 1-50 
1-20 to 1-16 


Agaricin 

Anemonin .... 


1-12 to 1-5 


1 to 2 
1-12 to 2-7 


Apomorphine. . 

Arbutin 

Asparagin 


1-15 to 1-10 
l-io 




7= per day 
1-6 


15 to 30 
1 to 6 



^Standard alkaloidal (dosimetric) granules. 



APPENDIX. 



195 



Drug Name. 

Aspido - sperm- 
ine 

Atropine sulph. 

Barosmin 

Baptisin 

Berberine sul- 
phate 

Bryonin 

Brucine 

Caffeine ...... 

Cannabin 

Cannabine tan- 
nate 

Caulophyllin.. . 

Chimaphilin.. . 

Cicutine(or Co- 
niine) 

Coniine hydro- 
bromate.. . 

Coniine hydro- 
chlorate 

Cocaine 

Codeine 

Codeine sulph. 

Colchicine .... 

Collinsonin .... 

Colocynthin . . . 

Convallamarin. 

Cornin 

Corydalin 

Cotoin ., 

Cypripedin 

Daturine 

Digitalin 

Dioscorein .... 

Elaterin 

Emetine (as an 
emetic) . . . 

Emetine (as an 
expectorant). 

Ergotin 

Euonymin, .... 



Billings. 



1-120 to 1-40 



2 to 5 

2 to 5 



1-30 to 1-15 
3 to 5 



1-6 to 1-2 



2 to 6 
1-5 to 1 



1-12 to 1- 



1-50 to 1-12 



5 to 10 
2 to 5 



Cerna. 



1-4 to i-£ 



2 to 5 



Gould. 



120 to 1-60 
2 to 3 



1 to 5 
2 to 10 



1-50 to 1-30 



xy 2 to 2 

I-I20 tO I-20 



1-2 to i or 2 



I-I20 tO I-80 

1-100 to 1-50 



I to 10 

1-4 tO 2 

1-10 to 1-3 
I to 5 



5 to 10 
2 to 5 
2 to 3 

1-60 to 1-10 

1-30 to 1-15 



I-» to 2 
1-2 tO 2 



I-I20 

2 tO 4 

1 to 1% 

I-4 tO 2 

2 tO 4 

I to 5 

1-2 tO I 
1-2 tO 3 



1-60 to 1-30 

1-2 tO 4 



1-8 to 1-4 

I-I20 tO I-4O 
1-2 tO 3 



S. G. 



ig6 



APPENDIX. 



Drug Name. 



Billings. 



Cerna. 



Gould. S. G. 



Gelseminine 
Gelsemin .... 
Gossypin .... 
Helenin .... 
Helonin .... 
Hydrastine. . 
Hyoscine. . . . 
Hyoscyamine 

Iridin 

Jalapin 

Juglandin . . . 
Koussein. . . . 
Leptandrin .. 
Lobeline(as an 

emetic ) .. . 
Lobeline (as an 

expectorant) 

Macrotin 

Menispermin. 
Muscarine. ... 

Napelline , 

Narceine 

Pelleterine sul 

phate 

Pelleterine 

tannate .... 
Physostigmine 

salycilate... 
Phytolaccin., . 
Pocrotoxin.. . . 
Pilocarpine . . 

Piperine, 

Podophyllin . . 
Podophyllo- . 

toxin ...... 

Populin 

Quassin 

Quinine arsen 

iate 

Sanguinarin 

nit 

Santonin 



1-300 to 1-200 



1-60 to 1-20 



1-6 to 1-3 



i-3 

1-130 to 1-65 

1-60 

1 to 5 



I-4 tO 1-2 
I-4 tO 1-2 



1-3 



15 to 30 

1-32 



1-6 to 1-2 



i-3 to 3-4 
5 to 7 
1 to 5 



1-80 to 1-20 
2 to 3 

I-I20 tO I-60 I-IOO tO I 
I-60 tO 1-2 



I to 



I to IO 



1-1000 to 1-10 



1-30 to 1-3 



1-60 to 1-20 

1-8 to 1 

1 to 5 



2 to 4 



1-30 to I 

1 to 5 

3 

2 to 5 



2 to 4 

1 to 3 

1-4 to 1-2 

1-2 to 2 

1 to 4 

I-IOO 

1-6 to 1-2 
i-4 



1-2 to I 



1 to 3 

1-60 to 1-20 

1-8 to 1-2 

1 to 10 

1-8 to 1 



1-6 to I 



2 tO 4; 



1-12 to 1-8 



1-10 to 1-4 



1-67& 1-6 





APPENDIX. 




197 


Drug Name. 


Billings. 


Cerna. 


Gould. 


S. G. 


Scutellarin .... 


i to 3 




1 to 2 
1 to 3 

1-25 to 1-5 
1-60 to 1-20 


1-6 


Senecin 




1-6 


Sparteine, sul- 
phate 

Strophanthin. . 
Strychnine .... 
Veratrine 


1-25 

1-60 

1-60 to 1-10 

1-60 to 1-20 


1-2 to 2 
1-100 to 1-60 


1-67 
1-500 
1-134 

1-134 
1-6 






Viburnin . ... 




1 to 3 









In referring to the above table, it must be borne in 
mind that the standard granule here given, does not 
always represent the dose in which the active prin- 
ciple has been found efficient, but may always be 
safely taken as minimum dosage, to be repeated with 
reasonable frequency until the desired effect is pro- 
duced. These are the sizes that can be obtained of 
the various granule manufacturers and have been 
found by careful experiment to be most satisfactory. 

When one takes into consideration the great vari- 
ation in dose recommended by standard authorities 
like Billings, Cerna and Gould, above quoted, it is no 
wonder that the active principle has fallen into dis- 
repute; and in view of the fact that most of the 
doses given are beyond the border-line of safety, 
not to say absolutely toxic, it is no wonder that the 
active principle is looked upon "with fear and 
trembling." 

Right here I desire to emphasize one thing upon 
which will depend, in a great measure, your success 
or failure in the use of the active principle. Always 
use the product of one manufacturer until you are 
sure you have found something better. 



INDEX.* 

Aconitine, 23. 

no danger from its use, 25. 
physiological action, 23, 26. 
the best antipyretic known, 27. 
tongue as a guide to its effect, 27. 
to be used in all kinds of fever. 
Adynamia, strychnine and digitalin in, 33. 
Agaricin, 39. 

Alcohol, strychnine substitute for, 176. 
Anemia, from calcium sulphide, 70. 

" glonoin in, 120. 
Angina pectoris, glonoin in, 117. 

" " morphine, in 136. 

Antagonism, between atropine and morphine, 140; 

and pilocarpine, 149. 
Antiperiodic, quinine as, 153. 
Anticipation of evil tendencies of disease, 174. 
Aortic regurgitation, sparteine in, 164. 

"Cardiac Tonic," 63. 
Appetizer, quassin as an, 153. 

" strychnine good. 

Apomorphine, 40. 

" in capillary bronchitis, 42. 

11 in laryngitis, 43. 

" in strychnine poisoning, 42 

Aperient, seidlitz salt, 161. 



*A word of explanation regarding the clinical feature 
of this index will not be amiss. It does not aim to be 
complete, simply referring to such direct suggestions, in 
the treatment of various conditions, as have been inci- 
dentally mentioned in illustrating the therapeutic scope of 
the active principles discussed. — Pub. 



INDEX. 199 

Arbutin, 48. 

Ascites, pilocarpine in, 146. 
Asparagin, 49. 

Asphyxia, glonoin in asphyxia of new born, 
in drowning, and from illuminating 
gas, 119. 
Asthma, atropine in 54. 

" coniine, 72. 

" glonoin, 118. 

" hyoscyamine, 124. 

" iobeline, 127. 

" morphine, 136. 

" sparteine, 165. 

" quinine, 158. 
Atropine, 16. 

Baldness, pilocarpine in, 150. 
Beef tea, 191. 

Biliary colic, hyoscyamine in, 124. 
Biliousness, bryonin in, 61. 
Bladder, inflammation of, arbutin, 48. 

" asparagin, 49. 

" codeine, 139. 

" hyoscyamine, 125. 
Boils, calcium sulphide, 68. 
Brain, inflammation of, ergotin, 104. 

" " " aconitine useful. 

Bright's disease, glonoin, 119. 
Bronchitis, aconitine for fever. 

" capillary, apomorphine in, 43. 

" emetine, 97, 98. 

" scillitine, 160. 

" strychnine, 43. 

Brucine, 168. 
Bryonin, 61. 

" and colchicine in stiff joints, 76. 
Caffeine, in coma, 64. 

" physiological action of, 64. 



200 INDEX. 

Caffeine, in shock and syncope, 66. 

" in typhoid fever and pneumonia, 66. 
" a substitute for alcohol, 66. 
Calcium Sulphide, 67. 

" " in measles, pertussis and scar- 

let fever, 68. 
Calomel, 128. 

Cancer, uterine, coniine, 73. 
Gelseminine, 112. 
Capillary bronchitis, emetine, 99. 

" " strychnine, 174. 

." " apomorphine, 43. 

" Cardiac Tonic " (from cactus grandiffora), 63. 
Cardiac tonic, quinine, 154. 

" " strychnine usually indicated. 

Carbuncles, calcium sulphide in, 68. 
Cathartics, atropine an aid to, 57. 
" podophyllin, 152. 

" Waugh's anticonstipation granules. 

Catarrhal diseases of respiratory tract, emetine 

in 97- 
Cerebral congestion, digitalin, 93. 

" ergotin, 104. 
Cerebral hemorrhage, ergotin, 104. 
Children, prescribing opiates for, 141. 
Cholera Infantum (and C. Morbus), calomel, 128. 

" " copper arsenite, 80. 

" " codeine, 137. 

" " diet, 190. 

" " hyoscyamine, 124. 

" " seidlitz salt, 162. 

" " zinc sulphocarbolate, 183-189. 

" " morphine and atropine hypo- 

dermically for adults. 
Chills, congestive, atropine to check, 55. 
Chorea, coniine, 72. 

" quinine, 158. 



INDEX. 201 

Codeine, 33. 

Colchicine, its physiological action, 74. 
" in gout and rheumatism, 75. 

Colic, atropine in all kinds, 56. 
" codeine in infantile, 142. 
" intestinal, copper arsenite, 80. 
" codeine, 137. 
" hyoscyamine, 124, 125. 
" morphine, 136. 
Collapse, glonoin in, 118. 

" caffeine, 64. 
Coma, caffeine in, 65. 

Congestion, atropine checks and prevents inter 
nal, 58. 
" cerebral, digitalin, 93. 

" " ergotin, 105. 

" malarial, quinine in, 105. 

Coniine, physiological action, 72. 
Constipation, podophyllin, 152. 
" seidlitz salt, 161. 

" strychnine, 170, 173. 

" Waugh's anticonstipation gran- 

ules. 
Convallamarin, 78. 
Convulsions, hyoscyamine, 125. 
Copper arsenite, 80. 

" ^ " method of administering, 81. 

Coryza, atropine cuts short acute, 53. 

" emetine, 98. 
Cough, hyoscyamine in spasmodic, 125. 
" lobeline, 127. 
" codeine, 139. 
" apomorphine in dry, 43. 
Croup, (aconitine for fever) apomorphine, 45. 
" emetine, 99. 
" calcium sulphide, 132. 
Cumulative action of digitalin, 90, 95. 



202 INDEX. 

Cystitis, arbutin, 48. 
" asparagin, 49. 

" lithium salts to render urine alkaline. 
Defervescent Compound, 36, 180. 

" " in asthenic cases 

only, 36. 
Delirium of fever, hyoscyamine, 121. 
" tremens, digitalin, 93. 
" " ergotin, 104. 

Diarrhoea, calomel, 128. 
" codeine, 137. 
" copper arsenite, 80. 
" dieting, 189. 

" emetine in green or slimy stools, 101. 
" rest, 192. 

" zinc sulphocarbolate, 184. 
Diabetes insipidus, ergotin, 105. 
" mellitus, codeine, 136. 

Diaphoretic, pilocarpine, 150. 
Digitalin, 84. 

" physiological action of, 86, 87. 
" contra-indications to use of, 90. 
" indications for use of, 87. 
11 strychnine improves action of, 172. 
" as a febrifuge, 94. 
Diphtheria, aconitine, 34. 
" calomel in, 132. 

" calcium sulphide, 68. 

li pilocarpine, 148. 

" strychnine, 174. 

Diuretics, arbutin, 48. 
" asparagin, 49. 
11 calomel, 133. 
" digitalin, 87. 
Dosimetric Trinity, 34. 

" one of the best combinations to treat 

asthenic fever, 94. 



HIDES 203 

Dropsy, bryonin. 61. 

caffeine 65. and 89. 
•* Dmel, 133. 

convallamarin. 78. 
digitalin, 87, 88. 
pilocarpine. 150. 
scillitine. Sg. 160. 
strophanthin. 167. 
Drunkenness, strychnine in :~~ 
rinetine. 99. 
hyoscyamize ::_= 
morphine. : 3 " 
enorrhcea. atropine. - ~ 
codeine, 139. 
coniine. " 
" gelseminizr ::_ 

glonoin, 116. 
oea. cardiac, • -cardiac ton i: . ' 63. 
: - vallamarin. ~ 
digitalin, 91. 
sparteine. 165. 
?psia, emetine, 101. 
quassin. 153. 

:hnme 170. 
I epsi d 
diastase. 

dieting of most importance. 
Z ::ema. gelseminine in prurites of, 112. 
:::ir _: 
emetine. 97. 
Emetine, its physiological action. 97, 
" method of administering, 99. 
as a hemostatic. 100. 
in bronchi ti s 
ralgia, hyoscyamine in. 124 
codeine. 
Entero-colitis, codeine and emetine, : - 



2o 4 INDEX. 

Enterocolitis, copper arsenite, 80. 
" seidlitz salt, 162. 

" zinc sulphocarbolate. 

Epilepsy, coniine in, 72. 
Ergotin, 102. 

" contra-indications, 103. 
" its physiological action, 104. 
" as a hemostatic, 106. 
Erysipelas, aconitine, 34. 

" atropine in faint eruption, 58. 

" calcium sulphide 68, 71. 

Expectorants, apomorphus, 41. 
" emetine, 97. 

" calcium sulphide, 68. 

" pilocarpine, 150. 

. " lobeline, 127. 

Facial neuralgia, aconitine and arseniate of 
quinine, 25. 
" •• atropine, 57. 

" " gelseminine, 112. 

Fever, aconitine in, 27. 

" kinds of fever requiring aconitine, 27. 
" seidlitz salt, 161. 
" premonitory symptoms of, 28. 
" symptoms of, 26. 
Food for diarrhoeal patients, 187. 
Gas, asphyxia from illuminating, glonoin, 11a 
Galactagogue, pilocarpine, 150. 
Gastric catarrh, emetine, 101. 

" " sulphocarbolate of zinc. 

Gastro-intestinal diseases, aconitine, 33. 
" codeine, 137. 
" copper arsenite, 80. 
11 how to treat them, 42. 
" their causes, 183. 
" seidlitz salt, 162. 
*' zinc sulphocarb., 185. 



INDEX. 205 

Gelseminine, 108. 

" its physiological action, 109. 

Glonoin, 114. 

" its physiological action, 114. 
Gonorrhoea, sulphocarbolate of zinc, 193 
Gout, colchicine in, 75. 
Headache, caffeine, 65. 

" rheumatic, colchicine in, 76. 

" ' " bryonin, 61. 

" congestive, ergot in, 104. 

Heart disease, aconitine in hypertrophy, 33-. 
digitalin, 85, 
" " glonoin, 117. 

" " painful palpitation, sparteine, 164. 

" " strophanthin, 166. 

Heart failure, caffeine, 69. 

" " glonoin, 118. 

Heart tonic, strychnine, 171. 
Hemoptysis, emetine in, 100. 

" ergotin, 106. 

Hemorrhage, internal, atropine, 56. 
H " digitalin 93. 

li " emetine, 100. 

" *' ergotin, 106. 

" " morphine, 136. 

" post-partum, digitalin, 92. 

" " ergotin, 103. 

" prevention of, 104. 

Hernia, hyoscyamine, 124. 
Hiccough, glonoin, 118. 
Hypnotic, action of hyoscyamine, 123. 
Hyoscyamine, 121. 

" its physiological action, 121. 

Hyoscine, 121. 

Hydrothorax, pilocarpine in, 146. 
Impotency, strychnine to restore lost power, 175. 
Incontinence of urine, atropine in, 56. 






2o6 INDEX. 



Incontinence of urine, ergotin, 105. 
Indigestion, intestinal, codeine, 138. 

" " copper arsenite, 80. 

" " zinc sulphocarbolate, 185. 

dieting, 187. 
" stomachic, codeine, 138. 

" " quassin, 153. 

Intermittent fever, quinine, 156. 
Intestinal diseases, zinc sulphocarbolate, 186. 

" " seidlitz salt, 167. 

Jaundice, catarrhal, podophyllin, 151. 
Joints, stiffness of, bryonin in, 62. 
Jugulation of fevers, aconitine, 28, 29. 

" " ." veratrine, 180. 

Labor pains, relief of false, gelseminine, 113. 

" " strychnine increases, 173. 

Laryngits, aconitine, 23. 

" apomorphine, 43. 

" emetine, 98. 

Laryngisimus stridulus, hyoscyamine in, 124. 
Leucorrhcea, zinc sulphocarbolate in, 193. 
Liver, torpid, bryonin, 61. 

" " podophyllin, 151. 

Lithium benzoate, 75, 76. 
Lobeline, 127. 

Lungs, aconitine in acute diseases of, 33. 
Lymphatic glands, calcium sulphide in suppura- 
tion of, 67. 
Malarial diseases, quinine, 156. 

" " strychnine, 172. 

Mania, hyoscyamine, 122. 

" digitalin in delirium of, 93. 
Measels, aconitine, 34. 

" calcium sulphide, 68. 
Meningitis, aconitine, 34. 

" gelseminine, 113. 

Mercury bichloride, 128. 



INDEX, 207 

Mercurial tremor, hyoscyamine, 125. 
Menorrhagia, atropine, 56. 
" ergotin, 106. 

Metritis, aconitine in, 33. 
Metrorrhagia, digitalin, 93. 
" emetine, 100. 

" ergotin, 106. 

Milk, atropine suppresses, 57. 

" pilocarpine stimulates, or augments the 
secretion, 149. 
Migraine, atropine cut short when face is pale, 57. 
" glonoin when face is pale, 118. 
" quassin, 153. 
Mitral valve, convallamarin, in diseases of, 78. 

" " sparteine in regurgitation, 165. 

Morphine, 135. 

" unpleasant effects of, 137. 

Mouth, inflammation, aconitine in, 32. 
Mumps, pilocarpine in, 149. 

Muscles, spasmodic action of, coniine in, 72. 
" -• " " gelseminine, in. 

Neuralgia, aconitine, 24. 
" atropine, 57. 

" colchicine, 76. 

" gelseminine, in. 

" morphine, 139. 

" quinine, 157. 

Neurasthenia, str)xhnine, 169. 
Night sweats, agaricin, 38. 
'• " atropine, 53. 

Nitro-glycerin, 114. 
CEdema, " cardiac tonic," 63. 
" calomel, 133. 

digitalin, 87, 88. 
" pilocarpine, 150. 
" sparteine, 164. 
" strophanthin, 167. 



208 INDEX. 

Opium poisoning, atropine, 140. 
Ovarian neuralgia, atropine, 57. 

" " gelseminine, 112. 

Overwork, digitalin and strychnine, 91. 
Pain, morphine, 140. 
" codeine, 137. 
" gelseminine, 112. 
Palsy, hyoscyamine, 125. 
Palpitation, convallamarin, 78. 
" digitalin, 91. 

" sparteine, 164. 

" from sexual excesses, tea, coffee, 

tobacco, " cardiac tonic," 63. 
Paralysis, strychnine, 69, 73, 75. 
Paralysis agitans, hyoscyamine, 125. 
Pelvic diseases of women, seidlitz salt in, 163. 
Pericarditis, chronic, bryonin in, 62. 
Peritonitis, aconitine, 33, 36. 

" " defervescent compound/' 36. 

" strychnine, 174. 

Pertussis, atropine, 54. 

" calcium sulphide, 68. 

" coniine, 73. 

" emetine, 99. 

Pharyngitis, aconitine in, 32. 

" emetine, 98. 

Phthisis, digitalin, 91. 

" strychnine in vomiting of, 171. 
" zinc sulphocarbolate in diarrhoea of , 184. 
Pilocarpine, 144. 

" contra-indications for use of, 146. 

Pleurisy, aconitine. 

" "defervescent compound," 36. 
" gelseminine, 113. 
" morphine for pain. 
" bryonin in chronic, 61. 
Pneumonia, aconitine for fever. 



INDEX. 209 

Pneumonia. •'• deferves. comp. ; ' in the robust. 36. 

caffeine, 64. 
Podophyllin. 151. 

Post partum hemorrhage, ergotin. 92. 103. 
" ° " digitaim. 92. 

" •• " emetine, 100. 

" " " strychnine as a pre- 

ventive, 174. 
Pulmonary hemorrhage, atropine, 56. 
" ergotin, 102. 

" emetine in recurrent, 100. 

• ' morphine to quiet mental excitement. 

Pulse, strophanthin in intermittent. 166. 

" sparteine. 165. 
Pruritus vulva, coniine, 72. 

gelseminine, 112. 
" " veratrine, 181. 

Ptyalism. atropine in. 53. 
Quassin, 153. 
Quinine, 154. 
Remittent fever, gelseminine. 113. 

" " quinine, 154. 

Renal colic, glonoin in, 116. 
" •• hyoscyamine. 124. 

" morphine and atropine hypoder- 
mically. 
Respiratory tract, treatment of diseases of. with 

aconitine. 33. 
Rigidity of os uteri, emetine. 99. 
•• •• " atropine, 56. 
Rheumatism, aconitine. 34. 
colchicine. 85. 
'• "defervescent compound." 36. 

" seidlitz salt. 163. 

" veratrine. 1S0. 

i( sodium salicylate in 10 to 15 gram 

doses every two hours. 



210 INDEX, 

Salivation, atropine to prevent, 128. 
Scarlet fever, aconitine for fever. 
" " calcium sulphide, 68. 

" ' " digitalin, 94. 
Sciatica, atropine, 76. 
" colchicine, 76. 
" gelseminine, 112. 
Sea-sickness, glonoin, 118. 

" arsenite of copper, 83. 

Secretions, atropine to check, 53. 
Seidlitz salt, 161. 
Serous cavities, bryonin in dropsy of, 61; also 

in chronic inflammation of. 
Scillitine, 160. 

" in bronchitis, 33. 
Sexual excesses, strychnine in, 175. 
Shock, atropine in, 55, 60, 89. 
" caffeine, 64. 
" strychnine, 176. 
Sialogogue, pilocarpine 150. 
Smallpox, aconitine, 34. 

" calcium sulphide, 68. 

Sodium benzoate, 75. 
Sparteine, 164. 
Spasms, apomorphine, 43. 
" aconitine if fever. 
Spermatorrhoea, digitalin, 94. 
" ergotin, 106. 

" camphor monobromide. 

Sprains, aconite, 24. 
Sputum, calcium sulphide in foul, 68. 

" digitalin in frothy and bloody, 63. 
" scillitine in tough, 160. 
Stimulant, strychnine as a, 171. 
Stomatitis, atropine to check secretion, 53. 

" sulphocarbolate of zinc for ulcera- 

tive, 193. 



INDEX. 211 

Stomachic colic, codeine. 137. 

" " copper arsenite, 82. 

Stomachic tonic, quassin, 153. 
Strophanthin, 166. 
Strychnine, physiological action, 168. 

" chloral hydrate as an antidote for 

strychnine poisoning. 169. 
Syphilis, mercury bichloride, 133. 
Teething, fretfulness of, hyoscyamine in, 176. 
Tenesmus of bladder and rectum, atropine, 56. 
" " " •• ■• hyoscyamine, 125. 

" ■• " " •'' morphine, 136. 

Tetanus, coniine, 72. 

" hyoscyamine, 125. 
Tinnitus aurium. glonoin, 118. 
Tobacco heart, strophanthin, 167. 

" •• •• cardiac tonic, " 63. 

Tongue, a guide to the action of aconitine, 27. 
Torpidity of liver, bryonin, 61. 

" " " podophyllin, 151. 
Typhoid fever, dosimetric trinity for fever. 

" " when heart is feeble, caffeine, 64. 

" " digitalin to sustain heart, 91. 

" " as an intestinal antiseptic, cal- 

omel, 130. 
" " for diarrhoea, and as an antiseptic. 

sulphocarbolate of zinc. 184. 
Urea and uric acid, to eliminate, colchicine, 75. 
Uremia, pilocarpine, 147. 
Urine, caffeine in suppression of, 65. 
" incontinence of, atropine, 56. 
" " ergotin, 105. 

" " stnxhnine, 172. 

Urticaria, gelseminine in pruritis of. 112. 
Uterine cancer, coniine, 73. 
" colic, glonoin, 116, 
" " morphine and atropine. 



212 INDEX. 

Uterine fibroid, ergotin, 102, 105. 
" hemorrhage, ergotin, 106. 
" inertia, strychnine, 173. 
Uterus, subinvolution of, ergotin, 105. 

" " " strychnine. 

Veratrine, 179. 
Vertigo, digitalin, 91. 

" in stomachic quassin, 153. 
Vomiting, calomel, 128. 

" copper arsenite, 80. 
" zinc sulphocarbolate, 184. 
" morphine and atropine, hypodermi- 
cally. 
Vomiting of pregnancy, emetine, n 1. 

" " '* strychnine, 170. 

Whooping cough, atropine, 54. 
" " coniine, 73. 

" " calcium sulphide, 68, 71. 

Zinc sulphocarbolate, 182. 
Zymotic diseases, calcium sulphide in, 68. 



